Page 24 - herina surgery and possible lawsuits

Table 5: Comparison of hernia classifications. [55]
Modified Nyhus-Stoppa Modified Gilbert Schumpelick/Arit

traditional [57] Aachen [58]

1 A Indirect small I 1 LI

B Indirect medium n 2 L2
C Indirect large nrn 3 L3
H A Direct small IIIA 4 M l
B Direct medium IIIA — M 2

C Direct large — 5 M3
in Combmed HIB 6 Me

IV Femoral m e 7 F
0 Other ■— — —
R Recurrent IV A, B, C, D — -------- .
(A- Direct, B- Indirect, C- Femoral, D- Combmation of A-B-C)

• For all practical purposes, the anatomic sites, namely, indirect (lateral), direct
(medial), and femoral appear to be universal, and recognition of the combined hernia

(pantaloon) with defects in both the direct and indirect area.
• For quantifying the defect size for indirect or direct defects, small is (<1.5 cm, or
approximately the tip of the fifth finger) or large (>3-4 cm, or two fingerbreadths in
width) seen as common. Medium defects are clear to Schumpelick (1.5-3 cm), but

judged empirically by Gilbert or by the loss of anatomic integrity of the direct floor
space by Nyhus.

• Only Bendavid had considered the extent of hernia sac as important to be added in
classification.
He proposed classification based on type, stage and dimension of defect (TSD)
where he staged hernia as-

(1) in the canal
(2) beyond external ring - not m scrotum
(3) Sac in scrotum

He suggested modifiers: Recurrence “R”, Slider “S”, Incarcerated “I”, Necrosis “N”.

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