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Wasteful overinvestigation — ultrasound in groin hernias and groin pain

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To the Editor: Surgeons detest the waste involved in routine ultrasounds for all patients with groin hernias and those with groin pain only.

An inguinal hernia is a groin swelling with a cough impulse, clinically obvious in nearly all patients. No additional value is obtained from an ultrasound, which does not change the management.

In addition, nearly all patients with groin pain without any noticeable swelling are now unfortunately appearing with an ultrasound “diagnosing” a hernia. Pain is often exercise-induced, felt in the inner thigh, and often present at night or when rolling over in bed. The ultrasound report will invariably declare “there is an indirect inguinal hernia containing fat” (sometimes the fat is labelled omentum). Commonly this is embellished with “a neck of 4 [or 6 or 8] mm”.

Unfortunate consequences ensue from mislabelling a mobile blob of fat protruding through the deep inguinal ring as an indirect hernia. The ultrasound, the second general practitioner visit and the surgeon’s visit add to delay and cost, and the true musculoskeletal, or occasionally neurogenic, cause of the groin pain is not assessed and treated.

The ultrasound report not infrequently leads to totally unnecessary surgical exploration of the groin to cure the “inguinal hernia”. The original musculoskeletal cause of groin pain persists,…