The use, value and safety of herniography

doi:10.1016/S0009-9260(99)90835-8

Clinical Radiology

Volume 54, Issue 7, July 1999, Pages 468-472

https://doi.org/10.1016/S0009-9260(99)90835-8 Get rights and content

Abstract

AIMS: To assess the safety, sensitivity and specificity of out-patient herniography when used to diagnose hernias in the presence of a normal or equivocal physical examination.

MATERIALS AND METHODS: This retrospective study reviewed the symptoms, clinical findings, radiological findings, surgical findings and clinical outcome of 112 patients referred for herniography over a 5-year period.

RESULTS: No significant complications were encountered. Thirty hernias were diagnosed. There was one false-positive and one false-negative examination giving herniography a sensitivity of 96.6% and a specificity of 98.4%.

CONCLUSION: Herniography is a sensitive, specific, safe and reliable investigation which should be available to and used by all surgeons who perform hernia repair operations.

References (14)

N.C Estes et al.
Role of herniography in the diagnosis of occult hernias
Am J Surg
(1991)
S.G Smedberg et al.
Herniography in athletes with groin pain
Am J Surg
(1985)
H.B Devin et al.
Management of Abdominal Hernias
J Karlsson et al.
Chronic groin pain in athletes
Sports Med
(1994)
G Lovel
The diagnosis of chronic groin pain in athletes: a review of 189 cases
Aus J Sci Med Sports
(1995)
P Kälebo et al.
Ultrasonography of chronic tendon injuries in the groin
Am J Sports Med
(1992)
A De Smet et al.
Magnetic resonance imaging of muscle tears
Skeletal Radiol
(1990)

There are more references available in the full text version of this article.

Cited by (31)

Is herniography useful and safe?
2011, European Journal of Radiology
Citation Excerpt :
In one of these cases the radiologist mentioned in his report that the patient was not keen to exercise or cooperate by doing provocative manoeuvres. Poor technique, mal-positioning, failure to take delayed films and adhesions can also lead to diagnostic pitfalls [9]. There were no false positive cases.
117 consecutive herniograms were reviewed for patients who had symptoms suggestive of hernia but with no evidence or inconclusive findings on physical examination. The traditional approach has been to explore patients with suspected occult hernias. The aim of this study was to assess the impact of herniography in minimizing needless groin exploration and to evaluate its safety. Thirty-three herniograms were positive and showed unilateral and bilateral inguinal hernias. There were no false positive examinations and two false negative examinations. No complications were present. Patients with positive herniograms were explored, and operative findings correlated well with herniographic findings. Twenty-four patients were referred to other specialities. Follow-up in clinic and telephone interviews showed symptomatic improvement in the majority of patients. Herniography is useful in evaluating obscure groin pain and occult hernias. It is a safe procedure and more cost effective than a negative exploration or diagnostic laparoscopy.
The role of ultrasound scan in the diagnosis of occult inguinal hernias
2011, International Journal of Surgery
Citation Excerpt :
In many centres ultrasound has superseded herniography in the diagnosis of groin pain. This is principally due to ultrasound’s benefit as a non-invasive modality with accurate and dynamic imaging of soft tissues without the complication risks of herniography.3 There is good evidence to show that ultrasound is very accurate in identifying clinically palpable groin hernias.
The aim of this study is to examine the role of ultrasound in conjunction with clinical judgment in diagnosing occult inguinal hernias in patients with groin pain.
The study involved a retrospective analysis of 297 patients who presented over an 18 month period from January 2007 to August 2008. All the patients presented to outpatient clinic with groin pain but a normal or equivocal clinical examination. Data was obtained from hospital records, radiology system and operation notes.
167 examinations (56%) were positive for a hernia, as a result of which 116 patients underwent surgery. At surgery, a hernia was found in 85 cases and no hernia was found in 31 cases. 130 examinations (44%) were negative for hernia. Six patients proceeded to surgery despite a negative ultrasound due to ongoing pain and a hernia was found in 5 cases. Overall, correlation with surgical findings showed ultrasound to have a sensitivity of 94%. Ultrasound used with clinical judgment has a positive predictive value of 73%.
Ultrasound scan alone in diagnosing groin hernias is not effective when correlated with operative findings. However in conjunction with clinical judgment it is a useful tool in diagnosing occult inguinal groin hernias and aiding in further management.
Pelvic Pain in the Athlete
2008, The Sports Medicine Resource Manual
CT herniography in the diagnosis of occult groin hernias
2005, Clinical Radiology
To evaluate the role of computed tomography (CT) after herniography in the diagnosis and management of primary and recurrent groin hernias not detectable on clinical examination.
Fifty-one patients underwent CT post-herniography over a 6-year period for suspected primary or recurrent inguinal hernia. The herniography and post-herniography CT findings were retrospectively compared with clinical and surgical follow-up. Statistical analysis was performed to assess the role of herniography and CT post-herniography in the primary and recurrent groups.
Of the 51 patients investigated for occult inguinal hernia, 19 had previous hernia repair with possible recurrence. The most common symptom at presentation was groin pain or discomfort (84%). Seventy-five percent in the primary group and 84% in the recurrent group had no findings on herniography or CT. Nine percent in the primary group and 16% in the recurrent group had hernias diagnosed by herniography. CT did not enhance the detection of hernia. Sensitivity for herniography and CT herniography in the primary groin hernia group was 75% as against specificity, which was 100 and 90%, respectively. For the recurrent groin hernias, sensitivity was 60% for herniography and 40% for CT herniography and specificity 100% for both.
CT performed post-herniography did not provide any benefit over performing herniography alone in the diagnosis of occult primary or recurrent inguinal hernias.
Herniography: A prospective, randomized study between midline and left iliac fossa puncture techniques
2001, Clinical Radiology
AIM: To determine whether an optimal site of injection exists for herniography. MATERIALS AND METHODS: This was a prospective, randomized study of 93 consecutive patients who were referred for herniography over a period of 9 months. Patients underwent either a left iliac fossa (LIF) or midline puncture. Parameters assessed included initial adequate needle placement, complications, pain scores and body mass index (BMI). The groups were compared using Chi-squared test for categorical data, Student's t-test for continuous data and the Mann–WhitneyU-test for skewed data, withP < 0.05 considered statistically significant RESULTS: Four complications were encountered (4%), and these were equally distributed between the two groups. Adequate initial positioning of the needle was similar in both groups. The volume of local anaesthetic used was correlated with discomfort using a pain scale: a volume of >6 ml resulted in significantly more pain. More frequent initial adequate needle placement was observed in thin patients (BMI < 45 kg/m²) with experienced operators. Conversely, increased body mass index resulted in more difficult needle placement. CONCLUSION: Herniography is a safe procedure with few complications. There was no significant difference comparing the midline and LIF approaches.Nadkarni, S.et al. (2001).Clinical Radiology56 , 389–392.
Evaluation and treatment of groin pain syndromes in athletes
2020, Annals of Joint

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Original paperThe use, value and safety of herniography

Abstract

Am J Surg

Am J Surg

Management of Abdominal Hernias

Chronic groin pain in athletes

Sports Med

The diagnosis of chronic groin pain in athletes: a review of 189 cases

Aus J Sci Med Sports

Ultrasonography of chronic tendon injuries in the groin

Am J Sports Med

Magnetic resonance imaging of muscle tears

Skeletal Radiol

Original paper
The use, value and safety of herniography