The Value of Preoperative Ultrasound in the Detection of Contralateral Occult Inguinal Hernia in the Treatment of Symptomatic Inguinal Hernia

Abstract

Background: The true incidence of contralateral occult inguinal hernia (OIH) is a debate. The repair of contralateral OIH in the treatment context of clinical symptomatic unilateral inguinal hernia (IH) is controversial. This study aimed to assess the effect and clinical benefit of preoperative ultrasound (US) in the diagnosis of contralateral OIH performed before surgery. Methods:The retrospective data of 155 consecutive male patients who underwent IH repair between January 2014 and January 2020 were analyzed. The surgical procedures for IH and the clinical outcomes of the US were evaluated.Results: Of 155 patients, 29 (18.7%) presented with bilateral IH. Preoperative US was performed in 73 cases of clinical unilateral IH (n = 126), and 30 (23.8%) patients were found to have a contralateral OIH. The totally extrapreperitoneal (TEP) or Lichtenstein repair was conducted. Bilateral IH repair was proposed for all, but only 28 agreed and underwent bilateral repair. Patients with clinically bilateral hernia had more complications compared with patients diagnosed to have occult contralateral IH after the US (n = 3 vs. n = 0). In the overall group, the TEP procedure resulted in shorter hospital stay (P = 0.001) and less pain (P = 0.021). Conclusions:The preoperative US may be recommended to assess the presence of a contralateral OIH as it is a noninvasive, radiationfree, widely available, relatively cheap diagnostic method. The preoperative US may change the surgical approach in up to 1/4 patients with a clinical unilateral IH. Either Lichtenstein repair or TEP repair can be performed with an acceptable complication rate in the case of OIH.

Diagnostic Accuracy of Imaging Modalities on Occult Groin Hernias According to Hernia type and a Surgeon-centered Individualized Groin Hernia Management Algorithm

“…6 However, the incidence of contralateral occult inguinal hernia reported in the literature differs according to the diagnostic method used. Reported incidence values vary as 23.8% to 34.6% in studies using USG as a diagnostic method, 7,8 33% in studies using CT, 9 and 5% to 58% in studies using intraoperative surgical exploration. 6 In this study, the occult contralateral hernia was detected in 26 (25.5%) of 102 patients who underwent TAPP repair, in line with the literature data.…”

Pre-operative factors associated with short- and long-term outcomes in the patient with inguinal hernia: What does the current evidence say?

“…In performing the literature review, it was found one systematic review and meta-analysis [ 22 ], one systematic review [ 23 ], two narrative reviews [ 24 , 25 ], one clinical trial [ 26 ], eight observational studies [ [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] ], and one case series [ 35 ], that discussed the relationship between some risk factors, interventions and outcomes in the management of inguinal hernia.…”

“…Other cohort studies, such as those developed by Wright et al [ 28 ], Pierides et al [ 29 ], and Jarrard et al [ 30 ], which studied hernia growth, pre-operative pain, compressive neuropathy, and the presence of occult contralateral hernias, showed that these factors contribute to the development and persistence of chronic post-operative pain, which is associated with the presence of abundant fibrosis in the external oblique fascia at the level of the inguinal ring [ 28 ], higher risk of recurrence (OR 6.77, p = 0.005), complications (OR 5.16, p = 0.002) [ 29 ] and reoperation [ 30 ]. In the case of occult contralateral hernias, Ozgur et al [ 31 ] evaluated the usefulness of ultrasound in the pre-operative detection of this condition, finding that approximately 25% of cases present occult hernias, modifying the overall outcome of patients having to be reoperated days later [ 31 ]. Although not with the same performance and ease of access, dynamic magnetic resonance imaging can also aid in the visualization of structures and post-operative monitoring of mesh placement or fluid presence [ 35 ].…”

“…

Fig. 1 Summary of pre-operative and surgical factors predicting overall outcome in inguinal hernia repair [ [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] ]. Created with BioRender.

…”