Herniography.

Herniographic examinations were performed on more than 4,000 patients. The method was found to be of great value in patients with obscure symptoms in the groin or pelvis. Herniography shows not only hernial sacs but also the general condition and tissue strength of the inguinal part of the abdominal wall. The different types of hernias have different signs that, as a rule, allow an exact diagnosis. The pelvic floor and the pouch of Douglas can always be evaluated. Young athletes with severe symptoms in the groin, in most instances, were found to have some type of hernial rupture and often osteochondritis in the pubic symphysis as well. In women, the clinical diagnosis of hernia is often difficult. Herniography was of great value in these patients.

Herniography: a diagnostic tool in groin symptoms following hernial surgery.

The diagnostic value of herniography for groin symptoms after hernial surgery was evaluated in 106 patients. When clinical examination indicated recurrent hernia, herniography was positive in 32 of 40 cases (80%). When no hernia was palpable, herniography revealed recurrence in 28 of 66 cases (42%). A narrow hernial neck was found in 33% of recurrent direct inguinal hernias. Preoperative herniographic findings were confirmed at subsequent surgery in 51 of 53 cases (96%). Postoperative herniography in symptomatic patients without palpable hernial recurrence increased the number of diagnosed recurrences by 44%. Herniography significantly adds to the reliability of clinical diagnosis, with specific information concerning type of recurrent hernia and appearance of the hernial neck.

Herniography of femoral, obturator and perineal hernias.

Positive contrast herniography was used in the workup of 550 patients with unclear groin pain. The majority of these patients had rather characteristic hernias of indirect, direct or femoral type. However, now and then diagnostic problems arose. A femoral hernia may look like a direct, indirect or even obturator hernia. There is also a variety of multilocular femoral hernias and other types. A femoral hernia may be present together with other hernias in the ipsilateral or contralateral groin. Obturator hernias are usually small but are always confined to the obturator canal laterally in the obturator foramen. Abnormalities in the pouch of Douglas may include a deep rectogenital pouch, diverticula and true herniations. These uncommon herniographic findings are described and discussed.

Herniography in athletes with groin pain.

In the years 1974 to 1981, herniography was performed in 78 athletes with groin pain. The investigation comprised 101 painful groin sides in 23 athletes with bilateral symptoms. Before herniography, a hernia was palpated in only eight (7.9 percent) groins with pain. Hernias were found at herniography in 84.2 percent of the symptomatic groin sides and in 49.1 percent of the asymptomatic groin sides. Sixty-three hernia operations were performed. The herniographic and operative diagnoses corresponded well. Direct hernias dominated among the operated athletes, and were found in 55.6 percent of those below 30 years of age. Altogether 69.8 percent of the operated patients were cured by hernia repair and another 20.6 percent were improved. Tenoperiostitis of the adductor muscles was the most frequent diagnosis in those not cured by operation and among the nonoperated patients. Herniography was of great value in selecting those patients who needed a repair. A broad differential diagnostic approach when examining these patients is of the utmost importance.

Herniography in the diagnosis of obscure groin pain.

Obscure groin pain was investigated in 250 consecutive patients (including 171 males) with no palpable hernia or previous hernia operation. Herniography revealed nonpalpable but symptomatic hernia in 51% of the male and 21% of the female patients. Among the hernia patients with bilateral pain, 40% had unilateral hernia. Direct-type hernia was most commonly found. Of the surgically treated patients, 87% were free from groin pain postoperatively. Further clinical investigations with a broad diagnostic approach gave a treatable diagnosis in 70% of the patients without hernia surgery. Spontaneous improvement occurred during the investigation in 25%, and the cause of groin pain remained unclear in 5% of the patients. Herniography is a valuable diagnostic tool in obscure groin pain and its use is justified at an early stage of investigation. "Blind" exploration can thus be avoided.

Herniography.

With some experience with the technique, herniography is easy to perform and involves very little inconvenience to the patient. This direct method for exact evaluation of the lower part of the abdominal wall and pelvic floor is useful and valuable for this common group of patients with symptoms in the groin or pelvis.

Ligation of the hernial sac?

In a prospective randomized study, the need for a high ligature of the hernial sac at operation for indirect hernia was studied. Herniectomy without ligation of the sac did not increase the recurrence rate. In addition, the nonligated patients had less pain in the postoperative period. Herniography was used pre- and postoperatively to improve the diagnostics.