Classification of Hernia

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A hernia is the protrusion of a viscus or part of a viscus through an

abnormal opening.

The most common location for hernia is the abdomen. The abdominal

wall – a sheet of tough muscle and tendon that runs down from the ribs to the

legs at the groins – acts as ‘nature’s corset’. Its function, amongst other

things, is to hold in the abdominal contents, principally the intestines. If a

weakness should open up in that wall, and it does not really matter how or

why it happened, the ‘CORSET EFFECT’ is lost and what pushes against it

from the inside (the intestines) simply pushes through the ‘window’. The

ensuing bulge, which is often quite visible against the skin, is the hernia.

These ‘windows of weakness’ commonly occur where there are natural

weaknesses in our abdominal wall – such as where the ‘plumbing’ goes

through it. Examples of these are the canals inguinal and femoral which

allow passage of vessels down to the scrotum and the legs, respectively.

Types of Abdominal Hernia

1.Inguinal hernia

2.Femoral hernia

3.Umbilical hernia

4.Incisional hernia

The most frequent of this is, Inguinal hernia which occurs in 73% cases.

CLASSIFICATION

I.ANATOMICAL TYPES: – Three types of classification can be made

under this heading.

a. According to the extent of the hernia it can be either

(a) A Bubonocele – when the hernia does not come out of the

superficial inguinal ring;

(b) An Incomplete Hernia – when it comes out through the

superficial inguinal ring but fails to reach the bottom of the scrotum, and

(c) Complete Hernia – when it reaches the bottom of the scrotum.

b. According to its site of exit it can be either

(a) An Oblique (Indirect) Hernia – when the hernia comes out through

the deep inguinal ring i.e. lateral to the inferior epigastric artery and

(b) A Direct Hernia – when it comes out through the Hesselbach’s

triangle which is bounded medially by the lateral border of the rectus

abdominis. Laterally by the inferior epigastric artery and below by the

inguinal ligament that means the neck of the sac lies medial to the

inferior epigastric artery.

c. According to the contents of the hernia, a hernia may be either

(a) An Enterocele – when it contains the Intestine (Enteron),

(b) An Epiplocele or Omentocele – when it contains omentum

(epiploon); or

(c) A Cystocele when it contains the urinary bladder.

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