[Ultrasound of inguinal hernias: morphological classification for a potentially conservative treatment in asymptomatic patients]

Abstract

Purpose: By using a standardized ultrasound procedure, it is possible to identify 3 types of hernias, which provide relevant information about the risk of incarceration based on morphological data. Therefore, conservative treatment is possible in asymptomatic patients. The aim of this paper is to demonstrate how the different hernia types are distributed, to evaluate the assessment for the risk of incarceration and to compare this management with "watchful waiting".

Materials and methods: Over the last 16 years we performed ultrasound examinations in over 7000 patients with preoperatively inguinal hernia and compared the findings to the intraoperative situs. From 1 / 1 / 2002 - 12 / 31 / 2007 we operated on 2758 patients with an inguinal hernia and treated 425 patients conservatively. Asymptomatic patients were checked annually and symptomatic patients were checked immediately.

Results: In all cases there was an exact correlation between the ultrasound description and the intraoperative finding in relation to the 3 hernia types: type A (bulge) 23 %, type B (tube) 55 %, type C (sandclock) 22 %. No case in the conservatively treated group required emergency operation.

Conclusion: Preoperatively inguinal hernias can be differentiated into 3 types by using sonomorphological criteria. Therefore, safe assessment of the need for operation is possible in asymptomatic patients. This procedure seems to be safer than "watchful waiting".