Value of routine pathology in herniorrhaphy performed upon adults

The value of routine pathologic study of specimens taken at herniorrhaphy performed upon adults was assessed. All 789 patients who underwent inguinal or femoral herniorrhaphy at the Long Island Jewish Medical Center from January 1983 through July 1984 were studied. Patients were classified into five groups; 1, no specimen was sent for pathologic evaluation; 2, confirmation of hernia sac; 3, confirmation of hernia sac with additional expected pathologic findings (such as lipoma or hydrocele); 4, unexpected additional pathologic findings which appeared abnormal at operation, and 5, unexpected additional pathologic findings which appeared normal at operation. During this time period there were 935 herniorrhaphy procedures performed. Three of 1,020 specimens examined contained unexpected pathologic findings (groups 4 and 5): non-Hodgkin's lymphoma, liposarcoma and atypical lipoma. Only one specimen (group 5) with an abnormal pathology report showed an atypical lipoma which appeared normal at operation (0.098 per cent). The outcome of the operation was not altered by the pathology results in these three patients from either group 4 or 5. Aggregate charges for all specimens was $30,528.00 (a mean charge per patient of $48.00). Annual savings to the health care system of the United States by omitting routine pathologic examination of specimens from groups 1, 2 and 3 would be $18 million. Although there may be some justification for routine tissue testing for medical and legal reasons and quality assurance purposes or for specimens which appeared abnormal at operation, these data suggest that for patients who undergo herniorrhaphy, little positive effect on the outcome is gained from routine pathologic examination of specimens which appeared normal at operation.