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The necessity of routine histologic examination of hernia sac, revisited
1Anatomic Pathology, University of Dammam, King Fahd Hospital of the University, Khobar, Saudi Arabia. aanemer@uod.edu.sa.
Insights
Routine histologic examination of hernia sacs (HS) is often unnecessary. Our study indicates that pathological findings in HS are rare and rarely impact patient care, suggesting a need for selective evaluation criteria.
Area of Science:
- Surgical pathology
- Hernia surgery outcomes
Background:
- Histologic examination of hernia sacs (HS) is a standard practice.
- The clinical utility and cost-effectiveness of routine HS examination are debated.
Purpose of the Study:
- To evaluate the necessity of continuing the current practice of routine histologic examination of hernia sacs.
- To determine the prevalence and clinical significance of pathological findings in HS.
Main Methods:
- Retrospective review of all HS received over 15 years for pathological findings.
- Selective re-examination of positive cases by a pathologist and chart review by a surgeon.
- Analysis of existing literature on HS pathologies.
Main Results:
- Pathological findings were identified in only 13.7% of adult HS and 12.8% of pediatric HS.
- None of the identified pathological findings had a significant impact on patient management or care.
- Literature review indicated that serious pathologies in HS are infrequent.
Conclusions:
- Routine microscopic examination of hernia sacs is not routinely justified.
- Implementing criteria for selective histologic evaluation can reduce workload and costs.
- Pathology reporting for HS should be based on specific indications rather than routine practice.
Purpose:
To validate the need of continuing the current practice of histologic examination of hernia sacs (HS).
Methods:
All HS received by our laboratory over 15 years were reviewed for any pathological findings. Cases harboring these results were selectively re-examined histologically by a pathologist and their charts were reviewed by a surgeon checking for clinical significance. Moreover, previous studies were analyzed to reach a final conclusion.
Results:
Pathological findings were noted in only 13.7 and 12.8% of adults and kids HS, respectively. None of these had significant impact on patient care.
Conclusions:
Serious pathologies reported in HS in the literature are rare. This, coupled with our data, suggest that the current practice of routine microscopic examination of HS is not justified. Criteria are proposed for categorizing cases as eligible for histologic evaluation. This will significantly reduce the workload and contain the cost.
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