Advertisement

Diagnostics of Inguinal Hernias

  • Baukje Van Den Heuvel
Chapter
First Online:

Abstract

For generations, careful physical examination of the groin in patients presenting with inguinal pathology has been regarded as an essential surgical skill. Already in the eighteenth century, the famous Dutch surgeon Petrus Camper emphasized: “Among the defects of our body there are none of any more concern therefore requiring precise investigation, than hernias” [12]. In current surgical practice, the presence of an inguinal hernia can be diagnosed quite accurately by history and physical examination, and additional diagnostic modalities are seldom needed [17, 28]. The presenting symptom of a groin hernia is either discomfort or pain in the groin in the majority of patients [10]. Approximately one third of all patients is asymptomatic at presentation and presents with the sign of a non-tender bulge in the groin.

This is a preview of subscription content, log in to check access.

References

  1. 1.
    Andrews BT, Burnand KG, Ferrar D. Putting a finger on the deep inguinal ring. J R Coll Surg Edinb. 1999;41:90–2.Google Scholar
  2. 2.
    Babkova IV, Bozhko VV. Ultrasound assessment in diagnosis of uncomplicated inguinal hernia. Khirurgiia (Mosk). 1999;2:46–50.Google Scholar
  3. 3.
    Bradley M, Morgan D, Pentlow B, et al. The groin hernia – an ultrasound diagnosis? Ann R Coll Surg Engl. 2003;85(3):178–80.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Burkhardt JH, Arshanskiy Y, Munson JL, et al. Diagnosis of inguinal region hernias with axial CT: the lateral crescent sign and other key findings. Radiographics. 2011;31(2):1–12.CrossRefGoogle Scholar
  5. 5.
    Cameron AE. Accuracy of clinical diagnosis of direct and indirect inguinal hernia. Br J Surg. 1994;81(2):250–2.CrossRefPubMedGoogle Scholar
  6. 6.
    Chung L, Norrie J, O'Dwyer PJ. Long-term follow-up of patients with a painless inguinal hernia from a randomized clinical trial. Br J Surg. 2011;98(4):596–9.CrossRefPubMedGoogle Scholar
  7. 7.
    Conaghan P, Hassanally D, Griffin M, et al. Where exactly is the deep inguinal ring in patients with inguinal hernias? Surg Radiol Anat. 2004;26(3):198–201.CrossRefPubMedGoogle Scholar
  8. 8.
    Fitzgibbons RJ Jr, Ramanan B, Arya S, et al. Long-term results of a randomized controlled trial of a nonoperative strategy (watchful waiting) for men with minimally symptomatic inguinal hernias. Ann Surg. 2013;258(3):508–15.CrossRefPubMedGoogle Scholar
  9. 9.
    Fitzgibbons RJ Jr, Giobbie-Hurder A, Gibbs JO, et al. Watchful waiting vs repair of inguinal hernia in minimally symptomatic men: a randomized clinical trial. JAMA. 2006;295(3):285–92.CrossRefPubMedGoogle Scholar
  10. 10.
    Hair A, Paterson C, Wright D, et al. What effect does the duration of an inguinal hernia have on patient symptoms? J Am Coll Surg. 2001;193(2):125–9.CrossRefPubMedGoogle Scholar
  11. 11.
    Hamlin JA, Kahn AM. Herniography: a review of 333 herniograms. Am Surg. 1998;64:965–9.PubMedGoogle Scholar
  12. 12.
    Ijpma FA, Van de Graaf RC, Van Geldere D, et al. An early observation on the anatomy of the inguinal canal and the etiology of inguinal hernias by Petrus Camper in the 18th century. World J Surg. 2009;33:1218–324.CrossRefGoogle Scholar
  13. 13.
    Jones RL, Wingate JP. Herniography in the investigation of groin pain in adults. Clin Radiol. 1998;53:805–8.CrossRefPubMedGoogle Scholar
  14. 14.
    Kark A, Kurzer M, Waters KJ. Accuracy of clinical diagnosis of direct and indirect inguinal hernia. Br J Surg. 1994;81(7):1081–2.CrossRefPubMedGoogle Scholar
  15. 15.
    Koliyadan SV, Narayan G, Balasekran P. Surface marking of the deep inguinal ring. Clin Anat. 2004;17:554–7.CrossRefPubMedGoogle Scholar
  16. 16.
    Korenkov M, Paul A, Troidl H. Color duplex sonography: diagnostic tool in the differentiation of inguinal hernias. J Ultrasound Med. 1999;18(8):565–8.CrossRefPubMedGoogle Scholar
  17. 17.
    Kraft BM, Kolb H, Kuckuk B, et al. Diagnosis and classification of inguinal hernias. Surg Endosc. 2003;17:2021–4.CrossRefPubMedGoogle Scholar
  18. 18.
    Moreno-Egea A, Girela E, Canteras M, et al. Accuracy of clinical diagnosis of inguinal and femoral hernia and its usefulness for indicating laparoscopic surgery. Hernia. 2000;4:23–7.CrossRefGoogle Scholar
  19. 19.
    Nadkarni S, Brown PW, van Beek EJ, et al. Herniography: a prospective, randomized study between midline and left iliac fossa puncture techniques. Clin Radiol. 2001;56:389–92.CrossRefPubMedGoogle Scholar
  20. 20.
    O'Dwyer PJ, Norrie J, Alani A, et al. Observation or operation for patients with an asymptomatic inguinal hernia: a randomized clinical trial. Ann Surg. 2006;244(2):167–73.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Poelman MM, van den Heuvel B, Deelder JD, et al. EAES consensus development conference on endoscopic repair of groin hernias. Surg Endosc. 2013;27(10):3505–19.CrossRefPubMedGoogle Scholar
  22. 22.
    Ralphs DN, Brain AJ, Grundy DJ, et al. How accurately can direct and indirect inguinal hernias be distinguished? Br Med J. 1980;12(280):1039–40.CrossRefGoogle Scholar
  23. 23.
    Sanjay P, Fulke JL, Shaikh IA, et al. Anatomical differentiation of direct and indirect inguinal hernias: is it worthwhile in the modern era? Clin Anat. 2010;23(7):848–50.CrossRefPubMedGoogle Scholar
  24. 24.
    Sanjay P, Reid TD, Bowrey DJ, et al. Defining the position of deep inguinal ring in patients with indirect inguinal hernias. Surg Radiol Anat. 2006;28:121–4.CrossRefPubMedGoogle Scholar
  25. 25.
    Scott PD, Willan PLT. Anatomical mythology? A study of surface markings of the inguinal region. Clin Anat. 1991;4(3):216–22.CrossRefGoogle Scholar
  26. 26.
    Simons MP, Aufenacker T, Bay-Nielsen M, et al. European Hernia Society guidelines on the treatment of inguinal hernia in adult patients. Hernia. 2009;13(4):343–403.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Tromp WG, van den Heuvel B, Dwars BJ. A new accurate method of physical examination for differentiation of inguinal hernia types. Surg Endosc. 2014;28(5):1460–4.CrossRefPubMedGoogle Scholar
  28. 28.
    Van den Berg JC, de Valois JC, Go PM, et al. Detection of groin hernia with physical examination, ultrasound, and MRI compared with laparoscopic findings. Investig Radiol. 1999;34:739–43.CrossRefGoogle Scholar
  29. 29.
    Van den Heuvel B, Beudeker N, van den Broek J, et al. The incidence and natural course of occult inguinal hernias during TAPP repair: repair is beneficial. Surg Endosc. 2013;27(11):4142–6.CrossRefPubMedGoogle Scholar
  30. 30.
    Zhang GQ, Sugiyama M, Hagi H, et al. Groin hernias in adults: value of color Doppler sonography in their classification. J Clin Ultrasound. 2001;29(8):429–34.CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of SurgeryVUMCAmsterdamThe Netherlands

Personalised recommendations

Cite chapter