Herniography and laparoscopic hernia surgery: Developments in the diagnosis and treatment of hernias

Patients who have groin pain in the absence of a palpable hernia or other standard diagnosis for the groin pain present a diagnostic and therapeutic dilemma. Hernia is the most common cause of the groin pain. In patients whose groin pain is difficult to diagnose, herniography, a positive contrast radiological examination of the peritoneal lining of the groin and pelvis, is of great value to disclose the presence of hernia. Using herniography, nonpalpable hernias are demonstrated with the same accuracy as palpable hernias; false negative investigations are rare. The importance of a careful clinical examination, in conjunction with the radiological examination, is emphasized. Over the last decade, laparoscopic procedures have been developed and used for hernia surgery. Reinforcement of the inguinofemoral area with a large overlapping mesh is currently the favored surgical treatment, with excellent short term results and few complications. At this time, no studies indicate that laparoscopic hernia repair Is superior to standard open-mesh procedures; clinical trials of medical and economic aspects are in progress.