Page 23 - herina surgery and possible lawsuits

Classifications

The concept of the indirect and direct areas dates back to Cooper in the 1840s, with

Hesselbach using the inferior epigastric vessels as the defining boundary between these two
areas.

• The majority of surgeons use traditional classification of groin hernias as indirect and
direct inguinal or femoral.[55]

• In 1958, McVay and Chaff classified pnmaiy, recurrent and combined hernias. He
also partitioned indirect hernias into small, medium, and large but did not use as

classification system. [56]
• Other clinical types include;
a) Reducible hernia- the contents return into the abdominal cavity by

themselves or by manipulation but the sac remains m position
b) Irreducible hernia- the contents can not be returned to the abdominal

cavity but there is no evidence of any other complication
c) Obstructed or Incarcerated hernia- (irreducibility + intestinal
(
> obstruction from within or without) the bowel in the sac is obstructed
but the blood supply is not compromised.

d) Strangulated hernia- (irreducibility + obstruction + arrest of the blood
supply) along with obstruction the blood supply of the bowel also
arrested.

• Rare hernias iare also classified as
a) Sliding hernia ( Hernia-en-glisssade)- a portion of the wall is formed by
!
another viscus eg. bladder or sigmoid colon.
b) Richters hernia- only a part of the circumference of the bowel is present

in the hernial sac.
c) Littres’ hernia- the hernial sac contains the Meckles’ diverticulum
d) Maydl’s hernia ( hernia-en-w)- W shaped loop of intestine in the sac.

Various classifications had been suggested by Nyhus, Stoppa, Gilbert, Rutkow & Robbins,

Aachen, Schumpelick and Zollinger but the utility of classification for the purpose of
decision making was limited and no single classification was accepted for reproducibility

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