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
  • 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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