Herniography influences the management of patients with suspected occult herniae and patient factors can predict outcome.

PURPOSE: Patients with groin pain and no palpable hernia are a diagnostic challenge for the surgeon. It is recognised that some patients will have an occult hernia and benefit from surgical repair. Herniography remains popular in some units, as it has a high diagnostic sensitivity.
METHODS: Presenting symptoms and signs were recorded, along with herniogram findings, management plan and outcome for all patients undergoing herniography between July 2004 and December 2009. Demographic factors and individual symptoms and signs were analysed for their ability to predict a positive herniogram.
RESULTS: There were a total of 72 positive and 132 negative herniograms. For positive herniograms, only 41 (59%) patients underwent surgery and six (16%) patients were found not to have a hernia. The most common reasons for not proceeding to surgery were herniogram findings thought to be insignificant and the herniogram being positive on the contralateral side. For negative herniograms, despite a negative herniogram, four (3%) patients underwent surgery and a hernia was confirmed in two patients. Regarding predictive symptoms and signs, history of a groin lump and greater patient age were significantly associated with a positive herniogram and a confirmed hernia at surgery.
CONCLUSIONS: After a positive herniogram, less than two-thirds of patients undergo surgery. The majority have improved symptoms on review and we, therefore, suggest a period of watchful waiting prior to herniography. Older patients and a history of a groin lump are associated with a positive herniogram and confirmed hernia at surgery, and could be used to select patients for laparoscopic exploration.