Maia S Anderson, MD1, Arielle E Kanters, MD, MS1, Jonathan Melendez, BS2, Dana A Telem, MD, MPH1. 1University of Michigan Department of Surgery, 2University of Michigan Medical School
INTRODUCTION: Studies have demonstrated wide variability in the sensitivity and specificity of ultrasound in determining the presence of groin hernias. Further, analyses of the accuracy of this modality in the diagnosis of specific types of groin hernias are lacking. In this context, we sought to investigate the correlation between ultrasound and intraoperative findings in groin hernias.
METHODS: This is a single center retrospective chart review of 187 patients who presented to the division of Minimally Invasive Surgery and underwent repair of a primary groin hernia between 1/2014 and 4/2017. After excluding patients without preoperative ultrasound, 54 patients were left for evaluation. Accuracy of physical exam and ultrasound findings for presence of groin hernia were calculated using intraoperative findings as the gold standard and compared using McNemar’s test. For each hernia type (direct, indirect, femoral), ultrasound diagnosis was compared to intraoperative findings using Fisher’s exact test.
RESULTS: A hernia was identified intraoperatively in all 54 patients with ultrasound results. A hernia was identified preoperatively by physical exam in 89% (n=48) of patients and by ultrasonography in 96% (n=52) of patients (p= 0.109). Intraoperative findings included 21 direct, 36 indirect, and 7 femoral hernias, with 10 patients presenting with multiple hernias identified at the time of surgery. Ultrasound correctly identified 33% (n=7) of direct, 56% (n=20) of indirect, and 14% (n=1) of femoral hernias. The total accuracy of ultrasonography for specific hernia type was 67%. Ultrasound results did not correlate with intraoperative findings for any particular hernia type. For female patients (n=8), ultrasound correctly identified 88% (n=7) hernias versus 50% (n=4) on physical exam. For patients with a BMI>30, ultrasound correctly identified 100% (n=15) of hernia vs. 80% (n=12) by physical exam.
CONCLUSIONS: While groin ultrasound accurately detected the presence of a hernia, specific hernia type was frequently misidentified using this imaging modality. Given that physical exam was equivalent in diagnosing the presence of a hernia, ultrasound may be redundant in the evaluation of patients with a clinically evident groin hernia. The poor sensitivity of ultrasound for hernia type also suggests the potential for misdiagnosis, which could be detrimental in the setting of a femoral hernia and could impact operative planning and execution in an open repair. Our study shows that ultrasound does not appear to have a clear benefit in the diagnosis of groin hernias and results should be viewed with caution.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 86873
Program Number: P020
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster