C V van Hessen1, M M Roos2, F B M Sanders3, E J M M Verleisdonk4, G J Clevers4, P H P Davids4, J P J Burgmans4. 1. Hernia Clinic, Department of Surgery, Diakonessenhuis Utrecht/Zeist, Room: Secretariaat Heelkunde, Professor Lorentzlaan 76, 3707 HL, Zeist, The Netherlands. cvhessen@diakhuis.nl. 2. Department of General Practice, Universitair Medisch Centrum Utrecht (UMCU), Utrecht, The Netherlands. 3. Department of Radiology, Diakonessenhuis Utrecht/Zeist, Zeist, The Netherlands. 4. Hernia Clinic, Department of Surgery, Diakonessenhuis Utrecht/Zeist, Room: Secretariaat Heelkunde, Professor Lorentzlaan 76, 3707 HL, Zeist, The Netherlands.
Abstract
PURPOSE: Physical examination (PE) combined with ultrasound (US) is recommended to confirm a recurrent hernia. However, the evidence is rather weak. The aim of this study was to evaluate PE and appraise the added value of US in alleged recurrent inguinal hernias after totally extraperitoneal (TEP) inguinal hernia repair. METHODS: All adult patients who were re-operated for suspicion of a recurrent hernia after a primary unilateral or bilateral TEP between 2006 and 2017 were identified and investigated retrospectively. Patient characteristics, PE, additional imaging and intra-operative findings were registered. PE outcomes were compared with intra-operative findings to calculate the positive predictive value (PPV) of PE. In case of clinical doubt, the added value of US was evaluated by comparing US findings with the intra-operative findings. RESULTS: A total of 130 patients were re-operated for suspicion of 137 recurrent hernias. In 75 patients, US was performed. PE was positive for an inguinal hernia in 101 groins (73.7%), negative in 30 (21.9%) and inconclusive in 6 (4.4%). PE matched the operative findings in 75.2%. The PPV of diagnosing a recurrent hernia (or lipoma) on PE was 97%. In case of clinical doubt (n = 36), positive US matched the operative findings in 20 cases (87.0%). CONCLUSION: US does not necessarily need to be incorporated in the standard diagnostic workup of a recurrent inguinal hernia. After PE alone, a recurrent hernia (or lipoma) can be diagnosed with a PPV of 97%. Only in case of clinical doubt, US has additional value.
PURPOSE: Physical examination (PE) combined with ultrasound (US) is recommended to confirm a recurrent hernia. However, the evidence is rather weak. The aim of this study was to evaluate PE and appraise the added value of US in alleged recurrent inguinal hernias after totally extraperitoneal (TEP) inguinal hernia repair. METHODS: All adult patients who were re-operated for suspicion of a recurrent hernia after a primary unilateral or bilateral TEP between 2006 and 2017 were identified and investigated retrospectively. Patient characteristics, PE, additional imaging and intra-operative findings were registered. PE outcomes were compared with intra-operative findings to calculate the positive predictive value (PPV) of PE. In case of clinical doubt, the added value of US was evaluated by comparing US findings with the intra-operative findings. RESULTS: A total of 130 patients were re-operated for suspicion of 137 recurrent hernias. In 75 patients, US was performed. PE was positive for an inguinal hernia in 101 groins (73.7%), negative in 30 (21.9%) and inconclusive in 6 (4.4%). PE matched the operative findings in 75.2%. The PPV of diagnosing a recurrent hernia (or lipoma) on PE was 97%. In case of clinical doubt (n = 36), positive US matched the operative findings in 20 cases (87.0%). CONCLUSION: US does not necessarily need to be incorporated in the standard diagnostic workup of a recurrent inguinal hernia. After PE alone, a recurrent hernia (or lipoma) can be diagnosed with a PPV of 97%. Only in case of clinical doubt, US has additional value.
Authors: Marleen M Roos; Wouter J Bakker; Nelleke Schouten; Charlotte E H Voorbrood; Geert Jan Clevers; Egbert Jan Verleisdonk; Paul H Davids; Josephina P Burgmans Journal: Ann Surg Date: 2018-08 Impact factor: 12.969
Authors: M Lacour; C Ridereau Zins; C Casa; A Venara; V Cartier; S Yahya; J Barbieux; C Aubé Journal: Diagn Interv Imaging Date: 2017-02-21 Impact factor: 4.026
Authors: Josephina P J Burgmans; Charlotte E H Voorbrood; Rogier K J Simmermacher; Nelleke Schouten; Niels Smakman; GeertJan Clevers; Paul H P Davids; EgbertJan M M Verleisdonk; Marije E Hamaker; Johan F Lange; Thijs van Dalen Journal: Ann Surg Date: 2016-05 Impact factor: 12.969