Inguinal hernia classification

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Template:F.k

Overview

[Disease name] may be classified according to [classification method] into [number] subtypes/groups: [group1], [group2], [group3], and [group4].

OR

[Disease name] may be classified into [large number > 6] subtypes based on [classification method 1], [classification method 2], and [classification method 3]. [Disease name] may be classified into several subtypes based on [classification method 1], [classification method 2], and [classification method 3].

OR

Based on the duration of symptoms, [disease name] may be classified as either acute or chronic.

OR

If the staging system involves specific and characteristic findings and features: According to the [staging system + reference], there are [number] stages of [malignancy name] based on the [finding1], [finding2], and [finding3]. Each stage is assigned a [letter/number1] and a [letter/number2] that designate the [feature1] and [feature2].

OR

The staging of [malignancy name] is based on the [staging system].

OR

There is no established system for the staging of [malignancy name].

Classification

• Inguinal hernia may be classified according to the integrity of the posterior wall and the deep inguinal ring, Nyhus classification, into 4 groups:
  • Type 1: indirect inguinal hernia with a normal inguinal ring, peritoneal sac is in the inguinal canal.
  • 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 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-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 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