title: A new accurate method of physical examination for differentiation of inguinal hernia types.
abstract: BACKGROUND
  It is generally stated that preoperative differentiation between indirect and direct inguinal hernias by physical examination is inaccurate and irrelevant. With the expansion of the laparoscopic technique, new relevance has emerged. Laparoscopic correction of an indirect hernia is more challenging and time consuming than laparoscopic correction of a direct hernia. Preoperative knowledge concerning the type of hernia informs the laparoscopic surgeon about the required expertise and the expected operative time, and this knowledge is useful for training programs and management. The authors therefore developed a new accurate and easy method of physical examination to differentiate types of inguinal hernia. A prospective study was conducted to determine the accuracy of this new method that combines physical examination with a hand-held Doppler device (not ultrasound) to differentiate types of inguinal hernia.
  
  
  METHODS
  This prospective diagnostics study consisted of two consecutive parts. Each part included 100 consecutive patients presenting with an inguinal hernia. The inguinal occlusion test was used to differentiate the types of inguinal hernia during physical examination in the first part of the study. A hand-held Doppler device was used for adequate localization of the epigastric vessels in addition to the occlusion test in the second part of the study. Preoperative remarks were compared with findings during laparoscopic inguinal hernia repair. The McNemar symmetry χ (2) test was used for statistical evaluation
  
  
  RESULTS
  The first part of the study showed a preoperative accuracy of 35 % for direct inguinal hernias and 86 % for indirect inguinal hernias (p < 0.001). The second part of the study showed a preoperative accuracy of 79 % for direct inguinal hernias and 93 % for indirect inguinal hernias (p < 0.001) CONCLUSION: The inguinal occlusion test combined with the use of a handheld Doppler device is accurate in distinguishing direct and indirect inguinal hernias and provides useful management information in laparoscopic inguinal hernia repair.
authors.affiliation: Department of Surgery, Slotervaarthospital, Louwesweg 6, 1066 EC, Amsterdam, The Netherlands, woutertromp@live.nl.
authors.forename: Wouter G
authors.initials: WG
authors.lastname: Tromp
authors.forename: Baukje
authors.initials: B
authors.lastname: van den Heuvel
authors.forename: Boudewijn J
authors.initials: BJ
authors.lastname: Dwars
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003937:Diagnosis, Differential; D005260:Female; D006552:Hernia, Inguinal / Q000175:diagnosis* / Q000601:surgery; D059685:Herniorrhaphy / Q000379:methods; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008297:Male; D008875:Middle Aged; D010808:Physical Examination / Q000592:standards*; D057234:Preoperative Period; D011446:Prospective Studies; D015203:Reproducibility of Results; D018608:Ultrasonography, Doppler; D055815:Young Adult