The Accuracy of Silk Glove Sign Compared with Inguinal Bulge in the Diagnosis of Indirect Inguinal Hernia in Children.

Abstract

Introduction: The diagnosis of indirect inguinal hernia is usually based on clinical grounds. Physical examination generally showed an inguinal bulge. However, when no bulge is seen, the silk glove sign (SGS) or palpating the processus vaginalis over the pubic tubercle can be useful. The aim of our study is to compare the accuracy of the presence of inguinal bulge with the presence of SGS. Materials and Methods: We conducted a retrospective of all patients undergoing laparoscopic inguinal hernia repair between January 2002 and November 2015. Preoperative diagnosis was obtained by physical examination. The presence of an inguinal bulge or SGS was considered diagnostic of indirect inguinal hernia. Intraoperative diagnosis was made to laparoscopic findings. The sample was divided into two groups: group 1 including the patient with inguinal bulge and group 2 including those with SGS. Results: A total of 1024 inguinal canals were evaluated. Inguinal bulge was observed in 379 inguinal canals (group 1), whereas SGS was detected in 196 (group 2). There were statistically significant differences between both groups regarding gestational age, birth weight, surgical age, and surgical weight. Prematurity and previous episodes of incarceration were statistically more common in group 1 (P < .001). The positive predictive value in group 1 was 98.7%, whereas in group 2 was 86.73% (P < .001). Conclusions: Although we have found that the success rate for accurate diagnosis is higher in patients with inguinal bulge, SGS can be useful in detecting indirect inguinal hernia.