K. Henderson2, S. Chua3, J. Hasapes3, K. Shiralkar3, J. Stulberg1, V. Tammisetti3, C. Thupili3, T. Wilson1, J. Holihan1 1University Of Texas Health Science Center At Houston, Department Of Surgery, Houston, TX, USA 2University Of Texas Health Science Center At Houston, Medical School, Houston, TX, USA 3University Of Texas Health Science Center At Houston, Department Of Diagnostic And Interventional Imaging, Houston, TX, USA
Introduction:
Occult inguinal hernias, or inguinal hernias that are not felt on physical exam, can often be seen on imaging. However, imaging may lead to over diagnosis of inguinal hernias, leading to unnecessary surgeon referrals, undue patient stress, and even unneeded surgery. The aim of this project was to develop consensus guidelines for the diagnosis of occult inguinal hernias using a Delphi technique.
Methods:
An expert panel of surgeons and radiologists was selected. Iterative rounds of surveys were administered to the panel. Panelists were asked to rate potential guideline topics by importance (on a 5-point Likert scale). Items rated 4 or 5 with 80% consensus were included for creation of guidelines. Next, panelists were asked open ended questions on what each guideline should be. A virtual meeting with all participants was conducted to discuss any areas without consensus and determine final guidelines.
Results:
Eight experts (3 surgeons and 5 radiologists) participated in the expert panel. There was initial consensus that criteria for occult inguinal hernia diagnosis (80% consensus) and best imaging modality for occult hernia detection (80%) should be included. There was also consensus that the radiology reports for studies assessing inguinal hernias should include hernia contents (80%) and hernia size (100%). An additional topic that was added based on survey feedback was clinical information to be provided to the radiologist when ordering an imaging study. Following the virtual meeting, the recommended diagnostic evaluation for an occult inguinal hernia is shown in figure 1. The following clinical information should be provided to the radiologist when ordering an imaging study: indication for ordering the study, patients symptoms, prior inguinal hernia surgeries. Items that should be included in a radiology report include whether the presence of an inguinal hernia was assessed, hernia contents, size of the defect, +/- hernia type.
Conclusion:
Occult inguinal hernia diagnosis can be challenging. This pathway is intended to standardize the diagnostic evaluation of occult inguinal hernias and improve communication between surgeons and radiologists. Future studies should include testing these guidelines in a prospective study.
