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{{Inguinal hernia}}


{{CMG}}; {{AE}} {{F.k}}
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==Overview==
==Overview==
Inguinal hernia may be classified according to integrity of the posterior wall and the deep inguinal ring into 4 groups.Inguinal hernia may be classified according to presence or absence of a peritoneal sac, size of the internal ring and integrity of the posterior wall of the canal into 5 groups.
Inguinal hernia may be classified according to integrity of the posterior wall and the [[deep inguinal ring]] into 4 groups. Inguinal hernia may be classified according to presence or absence of a [[peritoneal]] sac, size of the internal ring and integrity of the posterior wall of the canal into 5 groups.


==Classification==
==Classification==
*Inguinal hernia may be classified into several subtypes based on:
*Inguinal hernia may be classified into several subtypes based on:<ref name="pmid15851379">{{cite journal |vauthors=Holzheimer RG |title=Inguinal Hernia: classification, diagnosis and treatment--classic, traumatic and Sportsman's hernia |journal=Eur. J. Med. Res. |volume=10 |issue=3 |pages=121–34 |year=2005 |pmid=15851379 |doi= |url=}}</ref>
**Nyhus classification
**Nyhus classification
**Gilbert classification
**Gilbert classification
**Casten classification
**Casten classification
**McVay classification
**Mc Vay classification


*Inguinal hernia may be classified according to the integrity of the posterior wall and the deep inguinal ring, Nyhus classification, into 4 groups:  
=== Nyhus classification ===
**Type 1: indirect inguinal hernia with a normal inguinal ring, peritoneal sac is in the inguinal canal
*Inguinal hernia may be classified according to the integrity of the posterior wall, and the deep inguinal ring, into 4 groups:<ref name="pmid14533903">{{cite journal |vauthors=Zollinger RM |title=Classification systems for groin hernias |journal=Surg. Clin. North Am. |volume=83 |issue=5 |pages=1053–63 |year=2003 |pmid=14533903 |doi=10.1016/S0039-6109(03)00126-9 |url=}}</ref>
**Type 2: indirect hernia with an enlarged deep inguinal ring with the posterior wall intact, sac not in the scrotum
**Type 3: posterior wall (inguinal floor) defects:
***Type 3a: direct hernia with a posterior floor defect only
***Type 3b: indirect hernia with enlargement of deep inguinal ring and posterior floor defect
***Type 3c: femoral hernia
**Type 4: recurrent hernia


*Inguinal hernia may be classified according to the presence or absence of a peritoneal sac, size of the internal ring and integrity of the posterior wall of the canal, Gilbert classification, into 5 groups:
==== Type one: ====
**Type 1 hernias have a peritoneal sac passing through an intact internal ring that will not admit 1 fingerbreadth (ie,<1 cm.); the posterior wall is intact.
* Normal inguinal ring, [[peritoneal]] sac is in the inguinal canal.
**Type 2 hernias (the most common indirect hernia) have a peritoneal sac coming through a 1-fingerbreadth internal ring (ie, ≤2 cm.); the posterior wall is intact.
 
**Type 3 hernias have a peritoneal sac coming through a 2-fingerbreadth or wider internal ring (ie, >2 cm.).
==== Type 2: ====
**Type 3 hernias frequently are complete and often have a sliding component. They begin to break down a portion of the posterior wall just medial to the internal ring.
*Enlarged deep inguinal ring with the posterior wall intact, sac not in the scrotum
**Type 4 hernias have a full floor posterior wall breakdown or multiple defects in the posterior wall. The internal ring is intact, and there is no peritoneal sac.
 
**Type 5 hernias are pubic tubercle recurrence or primary diverticular hernias.
==== Type 3: ====
*Posterior wall (inguinal floor) defects:
**Type 3a:
***Direct hernia with a posterior floor defect only
**Type 3b:
***Indirect hernia with enlargement of deep inguinal ring and posterior floor [[defect]]
**Type 3c:
***[[Femoral hernia]]
**Type 4:
***Recurrent hernia
*Inguinal hernia may be classified according to the presence or absence of a [[peritoneal]] sac, size of the internal ring and integrity of the posterior wall of the canal, Gilbert classification, into 5 groups:<ref name="pmid2999775">{{cite journal |vauthors=Mukai T, Baba M, Akiyama M, Uowaki N, Kusakabe S, Tajima F |title=Rapid change in mutation rate in a local population of Drosophila melanogaster |journal=Proc. Natl. Acad. Sci. U.S.A. |volume=82 |issue=22 |pages=7671–5 |year=1985 |pmid=2999775 |pmc=391395 |doi= |url=}}</ref>
**Type 1:
*** Hernias with a [[peritoneal]] sac passing through an intact internal ring, unable to admit 1 finger breadth (ie,<1 cm.) and the posterior wall is intact.
**Type 2:
***Hernias with a [[peritoneal]] sac coming through a 1-finger breadth internal ring (ie, ≤2 cm.) and  the posterior wall is intact.
**Type 3:
***Hernias have a peritoneal sac that is able to accommodate a 2-finger breadth or wider internal ring (ie, >2 cm).
**Type 4:
***Hernias have posterior wall with either complete breakdown or multiple defects. There is intact inguinal ring with no peritoneal sac.
**Type 5:
***Hernias are pubic tubercle recurrence or primary [[diverticular]] hernias.
'''NOTE:''' Types 1, 2 and 3 are indirect hernias; types 4 and 5 are direct.
'''NOTE:''' Types 1, 2 and 3 are indirect hernias; types 4 and 5 are direct.


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**Class 2: medium indirect hernia
**Class 2: medium indirect hernia
**Class 3: large indirect hernia or direct hernia
**Class 3: large indirect hernia or direct hernia
**Class 4: femoral hernia
**Class 4: [[femoral hernia]]


==References==
==References==

Latest revision as of 19:51, 30 January 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Farima Kahe M.D. [2]

Overview

Inguinal hernia may be classified according to integrity of the posterior wall and the deep inguinal ring into 4 groups. Inguinal hernia may be classified according to presence or absence of a peritoneal sac, size of the internal ring and integrity of the posterior wall of the canal into 5 groups.

Classification

  • Inguinal hernia may be classified into several subtypes based on:[1]
    • Nyhus classification
    • Gilbert classification
    • Casten classification
    • Mc Vay classification

Nyhus classification

  • Inguinal hernia may be classified according to the integrity of the posterior wall, and the deep inguinal ring, into 4 groups:[2]

Type one:

  • Normal inguinal ring, peritoneal sac is in the inguinal canal.

Type 2:

  • Enlarged deep inguinal ring with the posterior wall intact, sac not in the scrotum

Type 3:

  • Posterior wall (inguinal floor) defects:
    • Type 3a:
      • Direct hernia with a posterior floor defect only
    • Type 3b:
      • Indirect hernia with enlargement of deep inguinal ring and posterior floor defect
    • Type 3c:
    • Type 4:
      • Recurrent hernia
  • Inguinal hernia may be classified according to the presence or absence of a peritoneal sac, size of the internal ring and integrity of the posterior wall of the canal, Gilbert classification, into 5 groups:[3]
    • Type 1:
      • Hernias with a peritoneal sac passing through an intact internal ring, unable to admit 1 finger breadth (ie,<1 cm.) and the posterior wall is intact.
    • Type 2:
      • Hernias with a peritoneal sac coming through a 1-finger breadth internal ring (ie, ≤2 cm.) and the posterior wall is intact.
    • Type 3:
      • Hernias have a peritoneal sac that is able to accommodate a 2-finger breadth or wider internal ring (ie, >2 cm).
    • Type 4:
      • Hernias have posterior wall with either complete breakdown or multiple defects. There is intact inguinal ring with no peritoneal sac.
    • Type 5:
      • Hernias are pubic tubercle recurrence or primary diverticular hernias.

NOTE: Types 1, 2 and 3 are indirect hernias; types 4 and 5 are direct.

  • Inguinal hernia may be classified according to Casten method into 3 stages:
    • Stage 1: an indirect hernia with a normal internal ring
    • Stage 2: an indirect hernia with an enlarged or distorted internal ring
    • Stage 3: all direct or femoral hernias
  • Inguinal hernia may be classified according to McVay method into 4 classes:
    • Class 1: small indirect hernia
    • Class 2: medium indirect hernia
    • Class 3: large indirect hernia or direct hernia
    • Class 4: femoral hernia

References

  1. ↑ Holzheimer RG (2005). "Inguinal Hernia: classification, diagnosis and treatment--classic, traumatic and Sportsman's hernia". Eur. J. Med. Res. 10 (3): 121–34. PMID 15851379.
  2. ↑ Zollinger RM (2003). "Classification systems for groin hernias". Surg. Clin. North Am. 83 (5): 1053–63. doi:10.1016/S0039-6109(03)00126-9. PMID 14533903.
  3. ↑ Mukai T, Baba M, Akiyama M, Uowaki N, Kusakabe S, Tajima F (1985). "Rapid change in mutation rate in a local population of Drosophila melanogaster". Proc. Natl. Acad. Sci. U.S.A. 82 (22): 7671–5. PMC 391395. PMID 2999775.

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