Surgical Referral and Early Diagnostic Imaging for Inguinal Hernias: A Qualitative Questionnaire Study of Australian Surgeons' Opinions.

Introduction Inguinal hernias are a pathology for which surgeons receive many referrals. Clinical examination remains the gold standard investigation when deciding whether an inguinal hernia repair is required. Despite this, referrals from primary caregivers will not infrequently include an ultrasound (US) or other imaging investigation. US use for the investigation of inguinal hernias in Australia is similarly on the rise. Additionally, there are no evidence-based recommendations on the imaging modality of choice when the diagnosis is less certain.  Purpose The aim of this study was to evaluate surgeons' experiences regarding radiological workup of inguinal hernias, particularly the prevalence of ultrasonography. Methods Short five-question surveys were sent out to general surgeons and sub-specialty surgeons from 2 December 2019 to 2 May 2020. Specialty surgeons included breast and endocrine, hepatobiliary, upper gastrointestinal, colorectal, paediatric, transplant, and trauma surgeons. Participation was voluntary. Data were collected using SurveyMonkey (SurveyMonkey HQ, San Mateo, CA), and data were not re-identifiable. Results Questionnaires were sent to 71 surgeons of different specialties. Fifty-six (78.9%) surgeons did not find US useful in hernia evaluation. Sixty-two (89.9%) would not recommend surgical intervention when clinical examination did not support US suggestive of a hernia. Despite these responses, 34 (54.8%) respondents viewed US as the most useful modality of investigation when imaging was required. Conclusions Over 75% of the surgeons do not recommend US in the routine workup of inguinal hernias. In cases where further investigation is required, US remains the modality of choice. However, the decision to utilize US may be better left to the operating surgeons themselves.