Santhosh P. V.1 , Ravindran Chirukandath2 , Babu P. J.3 , Revathy Prasanna Kumar4 , Harine Soubhagya5
BACKGROUND Inguinal hernias are one of the most common problems dealt by general surgeons and is the most common clinical entity evaluated by medical graduates. Deep ring occlusion test remains one important and most emphasized clinical test while discussing about inguinal hernia. This test helps in differentiating between direct and indirect inguinal hernia. The treatment is same in all types of hernia that is tension free mesh repair by open or laparoscopic repairs. METHODS In this prospective study we evaluated 252 cases of unilateral hernias with deep ring occlusion test, systematically correlated per operatively, and with reference to internal ring diameter. Quantitative data was analysed using sensitivity, specificity & appropriate statistical test of significance and presented. RESULTS Using deep ring occlusion test as the clinical test to differentiate between the direct and indirect inguinal hernias, 89 cases (35.3%) were indirect and 163 (64.68) were direct hernia. The per-operative findings showed 101 cases of direct hernias and 151 cases of indirect hernias accounting for 40.07% and 59.97% respectively. The sensitivity of the test still remains high (100%) but the specificity is only 59.1 % and the positive predictive value 75.40%. In direct hernias, the sensitivity is 100% and specificity is 50%; the positive predictive value is only 61.96%. The overall accuracy of the test in diagnosing direct hernias is 72.44%. In indirect hernias the sensitivity is only 70.89%, the specificity is 100% and the positive predictive value is 100%. The overall accuracy of the test in diagnosing direct hernias was only 79.47% CONCLUSIONS Deep ring occlusion test can be used as a supportive test to distinguish between direct and indirect hernias and multiple factors play a role in reducing the specificity, accuracy and positive predictive value of the test. Study points to the fact that it is a non-specific confirmatory test that helps in clinically differentiating direct and indirect hernias and its over emphasis in clinical evaluation method is unwarranted.
