Abdominal Wall Hernias: A Surgeon’s Advice for GPs
18 Feb 2026
Yet many patients arrive with imaging that is unnecessary, misleading, or misinterpreted, driving up healthcare costs and often leading to unneeded referrals or operations.
As President of the Australia and New Zealand Hernia Society (ANZHS), I encourage GPs to avoid routinely ordering groin ultrasounds and to manage patient expectations carefully. Patients should understand that:
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A sonographic hernia may not be real
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Surgery may not provide a solution
Collaboration between GPs, radiologists, and surgeons is key to improving patient outcomes, preventing unnecessary operations, and reducing costs. Over the past decade, hernia management has evolved significantly:
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Lifestyle interventions such as smoking cessation and weight loss improve outcomes
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Botulinum toxin A can increase abdominal wall compliance
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Robotics have advanced minimally invasive repair
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Artificial intelligence helps predict surgical complications
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Multiple repair options and dedicated centres of excellence now exist
Not every hernia needs surgery, and not every surgeon can manage complex abdominal wall pathology. High-resolution imaging allows accurate assessment of abdominal wall muscles and organs, but ultrasound reports are often suboptimal, particularly for groin pain, which has a wide range of causes.
Modern ultrasound detects small defects (<5mm) or fat in the inguinal canal, which are frequently misreported as hernias. Cord lipomas, found in up to 70% of people, are often mistaken for hernias but rarely require surgery. Imaging must always be interpreted in the clinical context, yet many patients are referred to surgeons solely based on an ultrasound report. This can lead to unnecessary operations, disappointed patients, and even long-term chronic pain.
Additionally, labelling a small or non-clinically significant hernia can impact employment checks or work-related injury investigations, delaying return to work. Imaging should be reserved for patients with clear bulges or clinical evidence of a hernia. Too often, patients are referred for scans without a thorough examination, wasting resources. In 2018, $39.8 million was spent on groin ultrasound rebates, a 13-fold increase since 2000.
Decisions about imaging—whether ultrasound, CT, or MRI—should be made by the clinician responsible for patient care. ANZHS is working with public hospitals and the Royal Australian and New Zealand College of Radiologists to improve ultrasound reporting, clarifying that most “irreducible fat-containing hernias” are in fact cord lipomas.
Key Takeaways for GPs:
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Do not order routine groin ultrasounds for patients without clinical signs of a hernia
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Educate patients about other causes of groin or abdominal pain
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Reserve imaging for positive examination findings
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Collaborate with radiologists and surgeons for better diagnosis and patient outcomes
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Be aware that sonographic-only hernias carry a higher risk of chronic post-op pain
Thoughtful evaluation and appropriate use of imaging can prevent unnecessary surgery, reduce costs, and improve patient care.
https://www1.racgp.org.au/
Source: Dr Rod Jacobs, Australia and New Zealand Hernia Society