Ultrasound of the inguinal floor for evaluation of hernias

Background: This study aimed to evaluate the utility of ultrasound in the diagnosis of inguinal hernias and obscure groin pain. Methods: A series of 65 consecutive groin explorations performed subsequently to percutaneous ultrasound examination were prospectively evaluated. Patients were examined in an office setting. The examination included a history and a physical. Then an ultrasound of the inguinal region was performed. Ultrasound was performed by the staff surgeon and fellows. Patients then were taken to surgery for either a laparoscopic or open hernia repair, The preoperative and operative findings were compared to determine the utility of groin ultrasound. Results: A series of 41 patients presenting with symptoms of groin pain or palpable groin bulge were evaluated with ultrasound of the groin. Of these patients, 24 went on to have bilateral repairs, bringing the study total to 65 groins. Surgery involved 50 laparoscopic and 15 open hernia repairs. This included 20 groins without hernia, as determined by physical examination, and 45 groins with a palpable hernia. Overall, ultrasound was used to identify the type of hernia correctly (direct vs indirect) with 85% success. In the 20 patients who had no palpable bulge, ultrasound identified a protrusion (hernia or lipoma) in 17. Two of these were false positives, and the three negative ultrasound examinations were false negatives. Thus ultrasound identified the pathology in a groin without a palpable bulge at an accuracy of 75%. The overall accuracy in finding a hernia of any kind by ultrasound was 92%. Conclusion: Ultrasound is a useful adjunct in evaluating the groin for hernia, and can be performed by surgeons.