Inguinal hernia classification: Difference between revisions
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*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> | *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: | **Type 1: | ||
Hernias | *** 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: | **Type 2: | ||
Hernias | ***Hernias with a [[peritoneal]] sac coming through a 1-finger breadth internal ring (ie, ≤2 cm.) and the posterior wall is intact. | ||
**Type | **Type 3: | ||
Hernias have a peritoneal sac | ***Hernias have a peritoneal sac that is able to accomodate a 2-finger breadth or wider internal ring (ie, >2 cm). | ||
**Type 4: | **Type 4: | ||
Hernias have | ***Hernias have posterior wall with either complete breakdown or multiple defects. There is intact inguinal ring with no peritoneal sac. | ||
**Type 5: | **Type 5: | ||
Hernias are pubic tubercle recurrence or primary [[diverticular]] hernias. | ***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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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
- Type 3a:
- 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 accomodate 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.
- Type 1:
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
- ↑ 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.
- ↑ 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.
- ↑ 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.