Comparison of Doppler Ultrasound and Clinical Features of Patients With and Without Femoral Hernia in Lower Extremity Venous Insufficiency Patients

ABSTRACT

In this study, we aim to evaluate Doppler ultrasound (US) and clinical features of patients with and without femoral hernia (FH) in lower extremity chronic venous insufficiency (CVI) patients.We retrospectively analyzed prospectively collected data of 1364 limbs with the CVI suspected. Femoral hernia was detected in 32 of the limbs, and the control group was formed with 32 limbs without FH. All limbs were evaluated with Valsalva maneuver and augmentation method to detect venous reflux in FH group. Venous reflux rates in the Doppler US, venous clinical severity scores (VCSSs), and clinical classes of Clinical-Etiology-Anatomy-Pathophysiology classification were compared statistically in both groups.The mean VCSS was 3.87 ± 0.74 in the FH group and 2.68 ± 0.65 in the control group, which was statistically significant ( P = 0.04). In the more severe clinical classes of Clinical-Etiology-Anatomy-Pathophysiology (C4-6), the number of limbs in the FH group was higher than in the control group (8 and 4, respectively). Doppler US examinations showed venous reflux in 22 of 32 limbs in the FH group and 19 of 32 patients in the control group, and there was a statistically significant difference ( P = 0.029). In the FH group, reflux could be shown only by augmentation method in the vast majority of limbs (16 of 22, 73%).In conclusion, VCSS and reflux rates are higher in limbs with CVI accompanied by FH. In addition, FH may cause false negative results in the evaluation of CVI. The use of augmentation method in limbs with FH can help avoid false negatives.

[China Guideline for Diagnosis and Treatment of Adult Groin Hernia (2018 edition)]

Inguinal hernia refers to an extraperitoneal hernia occurring in the inguinal region. The etiology of inguinal hernia is not completely clear, but is related to gender, age and family history. According to the anatomy of hernia, there are indirect hernia, direct hernia, femoral hernia, composite hernia and peripheral femoral hernia. According to the content of the hernia sac, it is divided into reducible hernia, irreducible hernia, incarcerated hernia and strangulated hernia. There are also several special types of hernia. Typical inguinal hernia can be diagnosed by medical history, symptoms and physical examination. If the diagnosis is unclear or difficult, the imaging examination can assist the establishment of diagnosis. Only through surgery, inguinal hernia in adult patients could heal. The following requirements should be fulfilled: (1)The surgeons need to acquire accreditation of medical residency and should have corresponding surgical training; (2)The qualification of laparoscopic surgeons require the completion of basic laparoscopic training and hernia fellowship training as well as passing relative examinations; (3)Training of hernia and abdominal wall surgeons should be completed in centers with corresponding qualifications; (4)Preoperative education should be provided to patients and/or their families, emphasizing the communication with patients before surgery and indicating the operation principle and measures, whether mesh should be used, and informed consent should be given. Hernia repair materials are mainly non-absorbable inert mesh. Surgery could be divided into two types: open and laparoscopic surgery, including tissue suture repair, repair with materials, total extraperitoneal repair (TEP) and trans-abdominal preperitoneal repair(TAPP), etc. Combined with the clinical practice in China,we completed the "Guideline for Diagnosis and Treatment of Adult Groin Hernia (2018 edition)" on the basis of the previous edition of the guideline. The relevant medical institutions and peers in China are requested to carry out this guideline according to actual clinical reference.

[Strangulated groin hernia still frequent in tropical milieu]

This study aimed to describe the epidemiological, clinical, therapeutic and postoperative data of strangulated groin hernia. Details of consecutive adults patients admitted to our emergency wards for strangulated groins hernia and operated on from august 1998 to december 2007 were recorded. In addition the mode of presentation, hernia type, treatment and outcome were also recorded for each case. The statistical analysis used the Chi2 test and the Fischer test. 149 strangulated groin hernias were recorded in 135 men and 14 women. Inguinal hernias were seen in 143 patients and femoral hernia in 6. Median age was 40 years. The mean delay for consultation was 2 days. Richter hernia, Maydl hernia and hernia abscess were seen in eight, two and three cases each. Bowel resection was required in 30 patients. Inguinal hernia underwent Bassini's procedure, Shouldice procedure and Mac Vay's procedure. While femoral hernia underwent only Mac Vay's procedure. No hernia repair was undergone in hernia abscess. Mortality was 10%. Bowel necrosis, long duration of symptoms, ASA class, bowel resection and strangulated groin hernia with hernia abscess, peritonitis and occlusion were found to be significant factors linked with unfavorable outcome. Morbidity was 16.7% and required reoperation in 9 patients; sepsis and hematoma were the most frequent complication. In conclusion, strangulated groin hernia still remain a frequent matter of consultation in visceral ward in tropical milieu. The high morbidity and mortality rate are unacceptable because of the possibility of avoiding them by early consultation and elective repair of groin hernia.

PELVIC ENDOMETRIOSIS WITH IRREDUCIBLE FEMORAL HERNIA

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