The accuracy of ultrasonography in classification of groin hernias according to the criteria of the unified classification system

Background The modern concept of type-related individualized groin hernia surgery imposes a demand for precise and accurate preoperative determination of the type of groin hernia. The aim of this prospective study was to evaluate the accuracy of ultrasonography in classification of groin hernias, according to the criteria of the unified classification system. Unified classification divides groin hernias into nine types ( grades): type I ( indirect, small), II ( indirect, medium), III ( indirect, large), IV ( direct, small), V ( direct, medium), VI ( direct, large), VII (combined-pantaloon), VIII ( femoral), and O ( other). Patients and methods One hundred and twenty-five adult patients with clinically diagnosed or suspected groin hernias were examined. Ultrasonography of both groins was performed with a 5 to 10-MHz linear-array transducer. Preoperative ultrasonographic findings of type of groin hernia were compared with the intraoperative findings, which were considered the gold standard. Results Total accuracy of ultrasonography in determination of type of groin hernia was 96% ( 119 of 124 correct predictions of type of groin hernia compared with surgical explorations). All hernias of types I, IV, V, VII, and VIII were correctly identified with ultrasonography ( sensitivity and specificity 100%). In the remaining five cases of the 124 ( 4%), hernia was incorrectly classified with ultrasonography: type VI ( direct, large) was misdiagnosed as type III ( indirect, large) in three cases, type III as type VI in one case, and type III as type II ( indirect, medium) in one case. The sensitivity and the specificity of ultrasonography in classifying type II were 100 and 99%, respectively, for type III, 85 and 97%, and for type VI, 90 and 99%. Conclusion Ultrasonography of the groin regions could be used with great accuracy for precise classification of groin hernias in adults. Each type of groin hernia, according to the unified classification system that we used for classification, has a characteristic ultrasonographic presentation, which is demonstrated in this study.