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Published in: Hernia 6/2019

01-12-2019 | Ultrasound | Original Article

Pain resolution in non-operatively managed ultrasound-only groin hernias: 3-year follow-up

Authors: A. Melloy, B. Paine, A. P. Wysocki

Published in: Hernia | Issue 6/2019

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Abstract

Background

General surgeons frequently see patients with groin lumps and pain. However, in the absence of a lump, an ultrasound scan identified groin hernia is a diagnostic and management challenge. Some surgeons recommend inguinal hernia surgery while others do not. The outcome of non-operative management is uncertain.

Methods

This study represents a minimum 3-year follow-up of all non-operatively managed patients seen in general surgical outpatient clinic over a 12-month period. To be included, patients needed to meet all four criteria: groin pain, no clinical hernia, groin hernia identified on ultrasound scan requested by the general practitioner and non-operative management. Patients were interviewed via a standardised telephone survey. Primary outcome measure was groin pain which was assessed with the Sheffield Pain score.

Results

From July 2014 to June 2015, 67 patients met the inclusion criteria. 42 participated (37 men and 5 women). Two-thirds were pain free (68%). Only 2 patients underwent hernia surgery. Women were more likely to describe developing a lump (60% vs 14%; p = 0.013), to see a surgeon (40% vs 8%; p = 0.039) and undergo hernia surgery (20% vs 3% p = 0.088).

Conclusion

At least in the medium term, non-operative management of men who present with groin pain (with an ultrasound scan reporting a hernia but no lump) is reasonable.
Literature
1.
go back to reference Ducouret E et al (2018) MRI in chronic groin pain: sequence diagnostic reliability compared to systematic surgical assessment. Skeletal Radiol 47(5):649–660CrossRef Ducouret E et al (2018) MRI in chronic groin pain: sequence diagnostic reliability compared to systematic surgical assessment. Skeletal Radiol 47(5):649–660CrossRef
3.
go back to reference Szopinski J et al (2012) Desarda versus Lichtenstein technique for primary inguinal hernia treatment: 3-year results of a randomized clinical trial. World J Surg 36(5):984–992CrossRef Szopinski J et al (2012) Desarda versus Lichtenstein technique for primary inguinal hernia treatment: 3-year results of a randomized clinical trial. World J Surg 36(5):984–992CrossRef
4.
go back to reference Ma C, Ramaswamy A (2016) The SAGES manual of groin pain. Springer International Publishing, Berlin Ma C, Ramaswamy A (2016) The SAGES manual of groin pain. Springer International Publishing, Berlin
5.
go back to reference Sanders DL, Kurzer M (2016) British Hernia Society: Groin Hernia Guidelines, in ISSUES IN PROFESSIONAL PRACTICE. Association of Surgeons of Great Britain and Ireland, London Sanders DL, Kurzer M (2016) British Hernia Society: Groin Hernia Guidelines, in ISSUES IN PROFESSIONAL PRACTICE. Association of Surgeons of Great Britain and Ireland, London
6.
go back to reference HerniaSurge Group (2018) International guidelines for groin hernia management. Hernia 22(1):1–165CrossRef HerniaSurge Group (2018) International guidelines for groin hernia management. Hernia 22(1):1–165CrossRef
7.
go back to reference Light D et al (2011) The role of ultrasound scan in the diagnosis of occult inguinal hernias. Int J Surg 9(2):169–172CrossRef Light D et al (2011) The role of ultrasound scan in the diagnosis of occult inguinal hernias. Int J Surg 9(2):169–172CrossRef
8.
go back to reference Depasquale R, Landes C, Doyle G (2009) Audit of ultrasound and decision to operate in groin pain of unknown aetiology with ultrasound technique explained. Clin Radiol 64(6):608–614CrossRef Depasquale R, Landes C, Doyle G (2009) Audit of ultrasound and decision to operate in groin pain of unknown aetiology with ultrasound technique explained. Clin Radiol 64(6):608–614CrossRef
9.
go back to reference Bradley M et al (2006) The positive predictive value of diagnostic ultrasound for occult herniae. Ann R Coll Surg Engl 88(2):165–167CrossRef Bradley M et al (2006) The positive predictive value of diagnostic ultrasound for occult herniae. Ann R Coll Surg Engl 88(2):165–167CrossRef
10.
go back to reference Alam A, Nice C, Uberoi R (2005) The accuracy of ultrasound in the diagnosis of clinically occult groin hernias in adults. Eur Radiol 15(12):2457–2461CrossRef Alam A, Nice C, Uberoi R (2005) The accuracy of ultrasound in the diagnosis of clinically occult groin hernias in adults. Eur Radiol 15(12):2457–2461CrossRef
11.
go back to reference Niebuhr H et al (2017) Groin hernia diagnostics: dynamic inguinal ultrasound (DIUS). Langenbecks Arch Surg 402(7):1039–1045CrossRef Niebuhr H et al (2017) Groin hernia diagnostics: dynamic inguinal ultrasound (DIUS). Langenbecks Arch Surg 402(7):1039–1045CrossRef
12.
go back to reference Campanelli G (2010) Pubic inguinal pain syndrome: the so-called sports hernia. Hernia 14(1):1–4CrossRef Campanelli G (2010) Pubic inguinal pain syndrome: the so-called sports hernia. Hernia 14(1):1–4CrossRef
13.
go back to reference Hussain A et al (2017) The value of laparoscopy in the management of chronic groin pain. Int J Surg 46:114–118CrossRef Hussain A et al (2017) The value of laparoscopy in the management of chronic groin pain. Int J Surg 46:114–118CrossRef
14.
go back to reference Ng WT, Chui LB (2008) Routine contralateral exploration is advisable during extraperitoneal hernioplasty for left inguinal hernia. Surg Endosc 22(3):806–807CrossRef Ng WT, Chui LB (2008) Routine contralateral exploration is advisable during extraperitoneal hernioplasty for left inguinal hernia. Surg Endosc 22(3):806–807CrossRef
15.
go back to reference Fitzgibbons RJ Jr et al (2013) Long-term results of a randomized controlled trial of a nonoperative strategy (watchful waiting) for men with minimally symptomatic inguinal hernias. Ann Surg 258(3):508–515CrossRef Fitzgibbons RJ Jr et al (2013) Long-term results of a randomized controlled trial of a nonoperative strategy (watchful waiting) for men with minimally symptomatic inguinal hernias. Ann Surg 258(3):508–515CrossRef
Metadata
Title
Pain resolution in non-operatively managed ultrasound-only groin hernias: 3-year follow-up
Authors
A. Melloy
B. Paine
A. P. Wysocki
Publication date
01-12-2019
Publisher
Springer Paris
Published in
Hernia / Issue 6/2019
Print ISSN: 1265-4906
Electronic ISSN: 1248-9204
DOI
https://doi.org/10.1007/s10029-019-01925-9

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