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Background <p>Ultrasonography (US) is increasingly used to aid in groin hernia diagnosis, but concerns remain regarding overdiagnosis, subtype misclassification, and limited evidence on orifice size measurement.</p> Methods <p>This retrospective diagnostic accuracy study was conducted at a single institution and included 884 patients (1,768 groins) who underwent laparoscopic groin hernia repair between 2007 and 2025. Preoperative upright US was compared with laparoscopic findings as the reference standard. Outcomes included diagnostic accuracy for hernia detection, concordance of subtype classification, and agreement of orifice size measurement.</p> Results <p>Among 798 groins assessed by upright US, sensitivity, specificity, and negative predictive value were 95.7%, 96.7%, and 93.4%, respectively. Physical examination showed lower sensitivity (89.8%) despite high specificity (99.4%). Subtype classification accuracy reached 91.6% with substantial agreement (Cohen’s κ = 0.791). Lateral inguinal and femoral hernias were identified with high accuracy, whereas combined types were often misclassified. Orifice size measurement by US demonstrated minimal bias (0.65&#xa0;mm) and proportional agreement with intraoperative findings; 68.7% of groins were within ± 5&#xa0;mm. Agreement was strongest for lateral inguinal and femoral hernias but limited for medial inguinal hernias.</p> Conclusions <p>Upright US provided excellent diagnostic performance and reliable subtype classification, with clinically acceptable concordance in orifice size measurement. When optimized, it can support both diagnosis and surgical planning in groin hernia management.</p>

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Diagnostic accuracy of upright ultrasonography for groin hernia compared with laparoscopic findings: a single-center study

  • 期刊论文

  • 发表日期：

    2026年3月23日

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  • Masanori Sato,
  • Kakeru Torii

摘要

Background

Ultrasonography (US) is increasingly used to aid in groin hernia diagnosis, but concerns remain regarding overdiagnosis, subtype misclassification, and limited evidence on orifice size measurement.

Methods

This retrospective diagnostic accuracy study was conducted at a single institution and included 884 patients (1,768 groins) who underwent laparoscopic groin hernia repair between 2007 and 2025. Preoperative upright US was compared with laparoscopic findings as the reference standard. Outcomes included diagnostic accuracy for hernia detection, concordance of subtype classification, and agreement of orifice size measurement.

Results

Among 798 groins assessed by upright US, sensitivity, specificity, and negative predictive value were 95.7%, 96.7%, and 93.4%, respectively. Physical examination showed lower sensitivity (89.8%) despite high specificity (99.4%). Subtype classification accuracy reached 91.6% with substantial agreement (Cohen’s κ = 0.791). Lateral inguinal and femoral hernias were identified with high accuracy, whereas combined types were often misclassified. Orifice size measurement by US demonstrated minimal bias (0.65 mm) and proportional agreement with intraoperative findings; 68.7% of groins were within ± 5 mm. Agreement was strongest for lateral inguinal and femoral hernias but limited for medial inguinal hernias.

Conclusions

Upright US provided excellent diagnostic performance and reliable subtype classification, with clinically acceptable concordance in orifice size measurement. When optimized, it can support both diagnosis and surgical planning in groin hernia management.