Inguinal hernia classification
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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 have a peritoneal sac passing through an intact internal ring that will not admit 1 fingerbreadth (ie,<1 cm.); the posterior wall is intact.
- Type 2 hernias (the most common indirect hernia) have a peritoneal sac coming through a 1-finger breadth internal ring (ie, ≤2 cm.); the posterior wall is intact.
- Type 3 hernias have a peritoneal sac coming through a 2-finger breadth or wider internal ring (ie, >2 cm).
- 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.
- 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.
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.