PREOPERATIVE NYHUS CLASSIFICATION OF INGUINAL-HERNIAS AND TYPE-RELATED INDIVIDUAL HERNIA REPAIR - A CASE FOR DIAGNOSTIC LAPAROSCOPY

The goal of this prospective study was to determine the clinical value (sensitivity and specificity) of preoperative hernia classification ( Nyhus classification) using three distinct methods: clinical examinati on, Doppler ultrasonography, and diagnostic laparoscopy. Thirty patien ts with 35 suspected groin hernias were included. Definitive hernia cl assification was achieved by laparoscopic peritoneal incision and diss ection of the inguinal floor. Twenty-eight laparoscopic hernia repairs followed. Sensitivity and specificity were calculated for each preope rative evaluation method. Clinical examination was found to be more ac curate than Doppler ultrasonography. The highest scores for sensitivit y (0.93) and specificity (1.00) were achieved, however, by diagnostic laparoscopy. Therefore, the authors consider diagnostic laparoscopy to be a valuable preoperative tool for assessing hernia type. An accurat e preoperative hernia classification will allow an individualized type -related hernia repair (open: anterior, posterior approach, or laparos copic: transabdominal preperitoneal, total preperitoneal, inner-ring c losure, mesh insertion).