Inguino-crural hernias: preoperative diagnosis and post-operative follow-up by high-resolution ultrasonography. A personal experience.

BACKGROUND: Hernia is an important pathology with an incidence of 5% in world population. The more affect region is the inguino-femoral. Normally the diagnosis was based on the clinical exam. A short time ago the high resolution ultrasonographic study was introduced. The purpose of our study was to value the sensitivity of US-HR in the preoperative diagnosis, in the postoperative follow-up and to compare the results to clinical exam.

METHODS: 140 patients affect by inguino-femoral hernia underwent this study, 112 inguinal hernias, 28 femoral, 8 pediatric patients. 106 patients underwent repair through the prosthesis, in 34 Halstad-Postempsky's technique was carried out. Ultrasonography studied: a) inguino-femoral region, cord and scrotum (the study was effected in basal condition and through Valsalva's manoeuver, decubitus changes); b) hernia content (omenutm, bowel); c) hernial orifice and of hernial content's transit (direct or indirect); d) the relation with the inguinal ligament; e) the vascularization (power-doppler) and the pathological situation (presence or absence of liquid in the sac, parietal thickness, presence/absence of peristalsis), in case of hernia complication; f) the presence/absence of simultaneous pathologies (hydrocele, varicocele, cord's cyst). The postoperative study was effected after 7 days, 1-6-12 months we have observed: a) haematomas and seromes (under the skin, under the aponeurosis, scrotal); b) prosthesis displacement; c) prosthesis infection; d) prosthesis reject; e) recurrence (importance, site); f) we have carried out the treatment of the complications (echoguided drainage of serous and hematic collection).

RESULTS: The sensitivity of US-HR in the diagnosis of hernia was 87.5%. The clinical exam arrived at an average of 72%, the comparison was favourable to US-HR (15.5%). The sensitivity in the diagnosis of complication arrived at an average of 85.5% for US-HR, and of 36% for clinical exam; the gap between the two techniques was elevated (49.5%).

CONCLUSIONS: The US-HR showed an important accuracy and sensitivity thus to cover today an important role, after the clinical exam, in the preoperative diagnosis and in the postoperative follow-up of the inguino-femoral hernias.