Anatomical differentiation of direct and indirect inguinal hernias: Is it worthwhile in the modern era?
Summary of "Anatomical differentiation of direct and indirect inguinal hernias: Is it worthwhile in the modern era?"
The study aimed to assess the clinical accuracy of differentiating direct and indirect inguinal hernias preoperatively by different grades of surgeons. A retrospective audit was conducted over a 9-year period and comprised all adult inguinal hernia patients operated by one consultant surgeon. The hernias were differentiated into direct and indirect hernias based on the direction of cough impulse and the deep ring occlusion test. The preoperative diagnosis was compared with intraoperative findings. During the study period, 503 patients were examined. Of these, 272 patients were diagnosed as having indirect hernias and 56 patients as having direct hernias. In 175 patients, no attempt was made to differentiate indirect and direct hernias. When compared with intraoperative findings, the diagnosis was correct in 77% of the indirect hernias and 55% of direct hernias. Of the patients in whom no differentiation was attempted, 115 patients had indirect hernias, 56 had direct hernias, and four had both. For indirect hernias, the diagnostic accuracy was 82, 63, and 30% for consultant, registrars, and senior house officers. For direct hernias, the diagnostic accuracy was 66, 50, and 44%, respectively. This study demonstrates relatively poor accuracy in diagnosing direct inguinal hernias regardless of seniority. Clin. Anat., 2010. (c) 2010 Wiley-Liss, Inc.
Affiliation
Department of Surgery, Royal Glamorgan Hospital, Llantrisant, Wales, United Kingdom.
Journal Details
This article was published in the following journal.
Name: Clinical anatomy (New York, N.Y.)
ISSN: 1098-2353
Pages:
Links
- PubMed Source: http://www.ncbi.nlm.nih.gov/pubmed/20641068
- DOI: http://dx.doi.org/10.1002/ca.21022
Medical and Biotech [MESH] Definitions
Hernia, Inguinal
An abdominal hernia with an external bulge in the GROIN region. It can be classified by the location of herniation. Indirect inguinal hernias occur through the internal inguinal ring. Direct inguinal hernias occur through defects in the ABDOMINAL WALL (transversalis fascia) in Hesselbach's triangle. The former type is commonly seen in children and young adults; the latter in adults.
Ovulation Detection
Method to determine the occurrence of OVULATION by direct or indirect means. Indirect methods examine the effects of PROGESTERONE on cervical mucus (CERVIX MUCUS), or basal body temperature. Direct ovulation detection, generally used in fertility treatment, involves analyses of circulating hormones in blood and ULTRASONOGRAPHY.
Inguinal Canal
The tunnel in the lower anterior ABDOMINAL WALL through which the SPERMATIC CORD, in the male; ROUND LIGAMENT, in the female; nerves; and vessels pass. Its internal end is at the deep inguinal ring and its external end is at the superficial inguinal ring.
Fluorescent Antibody Technique
Test for tissue antigen using either a direct method, by conjugation of antibody with fluorescent dye (FLUORESCENT ANTIBODY TECHNIQUE, DIRECT) or an indirect method, by formation of antigen-antibody complex which is then labeled with fluorescein-conjugated anti-immunoglobulin antibody (FLUORESCENT ANTIBODY TECHNIQUE, INDIRECT). The tissue is then examined by fluorescence microscopy.
Hernia, Abdominal
A protrusion of abdominal structures through the retaining ABDOMINAL WALL. It involves two parts: an opening in the abdominal wall, and a hernia sac consisting of PERITONEUM and abdominal contents. Abdominal hernias include groin hernia (HERNIA, FEMORAL; HERNIA, INGUINAL) and VENTRAL HERNIA.
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