Choosing Wisely:

Avoid the routine use of ultrasound in evaluating clinically apparent inguinal hernia.

Rationale and Comments: The diagnosis of, and subsequent treatment decisions for, palpable abdominal wall hernias are reliably made by patient history and physical examination alone. While the use of ultrasonography has been shown to be of some benefit in the diagnosis of occult hernias, there is no place for its routine use in the setting of a clearly palpable defect, as it only adds unnecessary cost and treatment delay with no useful contribution to definitive surgical care.
Sponsoring Organizations:
  • Society of American Gastrointestinal and Endoscopic Surgeons
  • Sources:
  • Society of American Gastrointestinal and Endoscopic Surgeons guideline
  • Disciplines:
  • Surgical
  • References: • SAGES guideline for laparoscopic ventral hernia repair. Available at:
    • Matthews RD, Neumayer L. Inguinal hernia in the 21st century: an evidence-based review. Curr Probl Surg. 2008 Apr. 45(4):261-312.
    • Robinson A, Light D, Kasim A, Nice C. A systematic review and meta-analysis of the role of radiology in the diagnosis of occult inguinal hernia. Surg Endosc. 2013 Jan;27(1):11-8.
    • Miller J, Cho J, Michael MJ, Saouaf R, Towfigh S. Role of imaging in the diagnosis of occult hernias. JAMA Surg. 2014 Oct;149(10):1077-80.

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