Recurrence after totally extraperitoneal (TEP) inguinal hernia repair: the role of physical examination and ultrasound

• Published in: Hernia : the journal of hernias and abdominal wall surgery 2020-02, Vol.24 (1), p.153-157
• Main Authors: van Hessen, C. V., Roos, M. M., Sanders, F. B. M., Verleisdonk, E. J. M. M., Clevers, G. J., Davids, P. H. P., Burgmans, J. P. J.
• Format: Article
• Language: English
• Subjects: Abdominal Surgery; Adult; Aged; Female; Groin; Hernia; Hernia, Inguinal - diagnosis; Hernia, Inguinal - etiology; Hernia, Inguinal - surgery; Hernias; Herniorrhaphy; Humans; Lipoma; Male; Medicine; Medicine & Public Health; Middle Aged; Original Article; Physical Examination; Predictive Value of Tests; Recurrence; Reoperation; Retrospective Studies; Ultrasonic imaging; Ultrasonography; Ultrasound
• ISSN: 1265-4906; 1248-9204
• DOI: 10.1007/s10029-019-02029-0

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.