The influence of ultrasound in the choice of surgical technique to repair inguinal hernia: a prospective multicentric cohort study

Abstract

Purpose Inguinal hernia is diagnosed by physical examination (PE) alone in most patients. Imaging is helpful if there is diagnostic doubt. A previous cohort study identified a high rate of diagnostic ultrasound (US) for inguinal hernias. This study aimed to evaluate the role of US in diagnosis and in the choice of surgical technique to repair inguinal hernias. Methods Multicenter prospective cohort of consecutive patients undergoing elective inguinal hernia repair between October and December 2019. Patients diagnosed with other image exams were excluded. The group of patients diagnosed with PE was compared to the group diagnosed with US. The primary outcome was surgical technique and a multivariable logistic regression model was used to test its association with US. Results A total of 911 patients from 33 Portuguese hospitals were included, 49.2% (448) with PE diagnosis and 50.8% (463) with a diagnosis supported with US. There were no statistically significant differences in the characteristics of the patients, symptoms or hernia type between the two groups. Lichtenstein was the most used surgical technique in both groups. There was no association between the use of US and the choice of surgical technique (adjusted odds ratio 1.02, 0.71-1.48, p=0.901). Conclusion The use of US had no impact on the choice of surgical technique to repair inguinal hernias and is not recommended routinely for diagnosis. Its use can increase costs of care and delay patients' treatment. A plan to decrease the use of the US is needed.