What’s the SCORE? Current management of symptomatic, clinically occult, radiologically evident inguinal hernias

Abstract

Introduction Symptomatic, clinically occult, radiologically evident inguinal hernias (SCORE-IH) are challenging due to diagnostic uncertainty and a lack of treatment consensus. This study explores current practice among surgeons treating SCORE-IH. Methods A trainee-led research collaborative (STEER) disseminated a validated online survey among UK and international consultants. Collated responses were analysed to determine surgeons’ experience and approach to the management of SCORE-IH. Results A total of 73 responses were received. Overall, 26% of respondents performed more than 100 IH repairs annually. Nearly two-thirds (62%) were unaware of SCORE-IH guidelines. Surgeons chose ultrasonography (31.5%) or ultrasonography with magnetic resonance imaging (24.6%) to manage SCORE-IH. Surgeons managed SCORE-IH conservatively or operatively in 31% and 36% of cases, respectively. Surgeons’ experience and laparoscopic capacity did not correlate with their approach to SCORE-IH management. Conclusions There is heterogeneity in SCORE-IH management, likely due to an absence of adequate guidelines. The results highlight that further SCORE-IH research is needed to achieve consensus.