Accuracy of clinical diagnosis of inguinal and femoral hernia and its usefulness for indicating laparoscopic surgery

Abstract

The preoperative diagnosis of inguinal hernias is one of the surgeon's most commonplace duties yet one of the least valued aspects in the treatment of this pathology. The introduction of the laparoscopic technique for inguinal hernia repair may stimulate an interest in this problem. The aim of the study is to analyse the diagnostic accuracy of clinical examination of inguinal and femoral hernias. 278 patients with a possible inguinal and femoral hernia received from the same surgeon a thorough clinical examination and preoperative diagnosis of the type of hernia (indirect or direct inguinal, and femoral). The data obtained were compared to the intra-operative findings. The influence of age, sex and site was studied with regard to the sensitivity of the clinical diagnosis. Direct inguinal hernias accounted for 35% of the total. Indirect inguinal hernias were diagnosed more accurately (85%) than direct (64%) and femoral (39%) hernias. Clinical diagnosis was not influenced by age, sex or site of the femoral hernia. Statistically significant differences were revealed only for inguinal hernias in the group of patients aged over 50 years and with a unilateral site (p<0.05). Thorough physical exploration should never be underrated in the diagnosis of inguinal hernias as it may help classify hernias with great accuracy.