Society of American Gastrointestinal and Endoscopic Surgeons

View all recommendations from this society

Released January 9, 2018; Updated January 19, 2022.

Avoid the routine use of ultrasound in evaluating clinically apparent inguinal hernia.

The diagnosis of, and subsequent treatment decisions for, palpable abdominal wall hernias are reliably made by patient history and physical examination alone. While the use of ultrasonography has been shown to be of some benefit in the diagnosis of occult hernias, there is no place for its routine use in the setting of a clearly palpable defect, as it only adds unnecessary cost and treatment delay with no useful contribution to definitive surgical care.

These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.

How The List Was Created

The SAGES Quality, Outcomes and Safety (QOS) Committee appointed a task force (composed of active members of the committee) to develop a list of potential recommendations after being provided with information and links to the Choosing Wisely® website. This group compiled a list of recommendations which fit the criteria outlined by the ABIM Foundation. A literature search was performed to ensure the recommendations were evidence-based. The task force then distributed the list to the full membership of the SAGES QOS Committee, asking the members of the committee to rank the recommendations by level of importance and clinical relevance. The top recommendations were discussed by the committee and selected for inclusion in this list. The list was reviewed and approved by the SAGES Executive Committee and SAGES Board of Governors.


SAGES guideline for laparoscopic ventral hernia repair. Available at:

Robinson A, Light D, Kasim A, Nice C. A systematic review and meta-analysis of the role of radiology in the diagnosis of occult inguinal hernia. Surg Endosc. 2013 Jan;27(1):11-8.

Miller J, Cho J, Michael MJ, Saouaf R, Towfigh S. Role of imaging in the diagnosis of occult hernias. JAMA Surg. 2014 Oct;149(10):1077-80.

E Piga , D Zetner , K Andresen , J Rosenberg, Imaging modalities for inguinal hernia diagnosis: a systematic review. Hernia. 2020 Oct;24(5):917-926