Opinion. The preoperative role of herniography: reappraising a forgotten technique?

Ever since their description in papyrus manuscripts more than 3500 years ago as “a swelling above the genitalia which appears on coughing” by the physicians in ancient Greece, groin hernias have been recognized as a frequently encountered clinical problem (1). The reported estimated lifetime prevalence of groin hernias is 25 per 100 persons (2). Surgery is the recommended definite therapy for symptomatic cases, whereas watchful waiting is often preferred in patients with minimal or no complaints. Given the high incidence of groin hernias and their related economic implications for the community, an accurate diagnosis is desirable to rule out other diseases and to avoid unnecessary surgery. Today, the diagnosis of a groin hernia is in the vast majority of cases still based on the combination of clinical symptoms and physical examination. In case of equivocal clinical findings, various imaging techniques have been evaluated to confirm or rule out the presence of a hernia. Among them, herniography has been proven to be a save and highly accurate diagnostic procedure, but the technique has not gained widespread acceptance in the daily clinical routine. In this manuscript we will review and discuss pre-operative imaging in the work-up of occult groin hernias with emphasis on the role of herniography. The discussion is restricted to patients who did not undergo previous surgery for hernia