The Influence of Ultrasound in the Choice of Surgical Technique to Repair Inguinal Hernia: A Prospective Multicentric Cohort Study

Background Inguinal hernia is diagnosed by physical examination (PE) alone in most patients. Imaging is helpful if there is diagnostic doubt. A previous cohort study identified a high rate of ultrasound (US) use to diagnose inguinal hernias. This study assessed if the use of US influenced the choice of surgical technique to repair inguinal hernias. Methods Multicenter prospective cohort study of consecutive patients undergoing elective inguinal hernia repair between October and December 2019. Patients diagnosed with other image exams were excluded. The group of patients diagnosed with PE was compared to the group diagnosed with US. The primary outcome was surgical technique. The association between use of US and choice of surgical technique was tested through a logistic regression model. Results A total of 911 patients from 33 Portuguese hospitals were included, 49.2% were diagnosed with PE only and 50.8% had an US. There were no statistically significant differences in the characteristics of the patient, symptoms or hernia between the two groups. Lichtenstein was the most used surgical technique in both groups. There was no association between the use of US and the choice of surgical technique (adjusted odds ratio 1.02, 0.71–1.48, p = 0.901). Conclusion The use of US had no impact in the choice of surgical technique to repair inguinal hernias and is not recommended for their diagnosis. Its use can increase costs of care and delay patients' treatment. A plan to decrease the use of the US in this setting is needed.