Hernia sacs: is histological examination necessary?

Introduction

The hernia sac is a common specimen in surgical pathology that can yield a wide variety of pathological findings. However, there is debate as to whether routine microscopic examination is necessary. Several studies have demonstrated that routine submission of paediatric inguinal hernia sacs is unnecessary due to the low yield of unexpected findings. 1-3 In adults, some institutions do not routinely examine inguinal hernia sacs microscopically, but abdominal wall hernias are usually examined. 4 5 The College of American Pathologists recommends that all adult hernia sacs be submitted to pathology, but leaves the decision of microscopic examination of inguinal hernia sacs to the discretion of the pathologist/institution. 6 To validate this approach, we investigated the frequency and types of pathologies found in hernia sacs and whether the findings affected patient management.

Materials and methods

A retrospective review was performed of the University Health Network (UHN) pathology database for all surgical specimens from adults submitted as 'hernia sac' between 2001 and 2012. Specimens from surgeries performed at UHN primarily for symptomatic groin and abdominal wall hernias were included. Thus, specimens submitted as part of larger oncological surgeries were excluded from analysis. Pathology reports were reviewed for information related to clinical information, final diagnosis, and macroscopic and microscopic comments. Select cases were reviewed histologically.

Results

All hernia specimens at our institution are sent for pathological examination and the vast majority (98.5%) were examined microscopically. A total of 1426 groin and abdominal wall hernia sac submissions were derived from primary hernia surgeries performed at UHN. A breakdown of their location is shown in table 1 . The majority were inguinal hernias and a substantial number were from the abdominal wall. The pathological diagnoses are listed in tables 2 and 3 .

Table 1

Location	Number	Gross only examination
Inguinal	800	17
Femoral	50	0
Abdominal wall	576	5

Table 2

Diagnosis	No.
No pathology or just inflammation	530
Lipoma	238
Intestines	14
Appendix	3
Vas deferens*	3
Chronic lymphocytic leukaemia	2
Omentum	2
Undescended testis	1
Endometriosis*	1
Bladder tissue*	1
Adenomatoid tumour*	1
Adenomyoma*	1
PEComa*	1
Pseudomyxoma peritoneii*	1
Cholangiocarcinoma*	1

*Precise pathology unknown until after histological examination.

Table 3

Diagnosis	No.
No pathology or just inflammation	507
Omentum	36
Intestines	21
Lipoma	5
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