Abdominal Wall Ultrasound To Substantiate Diagnostic and Treatment Algorithms of Inguinal Hernia.

Abhijit Mahanta, MD, MS, DMAS, FMAS, Fedor Ilchenko, Professor, DM. Crimea state medical university

Introduction: This study analyzes the clinical features and feasibility of ultrasound findings of the inguinal regions to justify diagnostic and treatment algorithm for patients with inguinal hernia.

Materials and methods

Total 51 male patients with inguinal hernia were examined in age group of 28 to 56 years. Besides general clinical examination, they underwent ultra sound of groin area with real time linear transducer with frequency of 3.5-7.0 MHz scan speed. The study were conducted with a full urinary bladder. Initially the linea alba, rectus and lateral anterior abdominal muscle groups of abdominal wall were investigated. All the layers of the abdominal wall and the point of fixation to the pubic bone were visualized. On both sides, the inguinal triangle height was defined and also evaluated the condition and size of external and internal inguinal rings. The hernia sac (its contours clearly defined on pressure and coughing) and its contents were identified. Iliac vessels were visualized. To visualize the external inguinal ring sensor were placed parallel to the outer edge of the rectus muscle in the projection of the medial inguinal fossa. For visualization of the internal inguinal ring sensor were placed lateral to external iliac vessels and perpendicular to the inguinal ligament. Ultrasound signs of inguinal hernia was inguinal triangle with a visualization of the hernia sac, wide internal inguinal ring in the area of ??the neck of the hernia sac visualized in oblique hernias.

Results of the study

According to physical examination and ultrasound findings following types of hernias were diagnosed:

I oblique hernia with extended inner ring -5 patients ;
II oblique hernia with extended inner ring – 34 patients;
III oblique hernia with disrupted inner ring – 6 patients;
IV direct hernia with a large posterior wall defect in 2 patients;
V direct hernia with a small rear wall defect – 8 patients;
VI combination of oblique and direct hernias – 1 patient;
VII femoral hernia – 1 patient;
VIII – recurrent hernia – 6 patients.

All patients were performed Totally Extra Peritoneal hernia repair (???).

In 9 patients with type III hernia – 6 patients; IV type – 2 patients, and type VI – 1 patient mesh was fixed to the pubis symphysis, transverse fascia and hernia repair was performed.

During the operation, data obtained in ultrasound was confirmed in 42 patients (84.3%). 9 patients were also diagnosed with bilateral inguinal hernia, which was not diagnosed during physical examination.

Conclusions

1. Ultrasound of groin is a informative method to diagnose the type of inguinal hernia. The obtained data on the characteristics echo anatomy of abdominal wall can be used to select individual methods of hernia repair in a specific patient.

2. In patients with inguinal hernias types III, IV, and VI, repair of internal inguinal ring is advisable to carry out the and fixation of the implant to the ilio- pubic region with continuous absorbable suture. Fixation with fibrin glue can also be carried out.

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