Types of Inguinal Hernias
Naturally, before moving forward with an inguinal hernia repair, it is very important determine what type of inguinal hernia you have.
Even an experienced surgeon can have difficulty determining from a physical examination what type of hernia the patient has. In that case, an ultrasound can be very helpful. The ultrasound should be done while the patient is standing and with the patient increasing the intra-abdominal pressure with a valsalva maneuver.
The photo below represents the inguinal anatomy:
The Three Types of Inguinal Hernias
Type 1: Indirect Inguinal Hernia
The first type of inguinal hernia is an indirect inguinal hernia or sometimes called a congenital inguinal hernia. This type of hernia develops because the testicle needs a hole in the abdominal wall to allow the testicle to pop out of the pelvis and then drop down into the scrotum just before a young man is born. After the testicle passes through the hole in abdominal wall, that natural hole is supposed close. If the hole does not close, then at later date the hole can dilate and allow intestines to slide out through the hole and create a bulge under the skin. This type is usually very easy to identify on physical examination. The bulge follows the spermatic cord and the bulge starts lateral the epigastric vessels.
Type 2: Direct Inguinal Hernia
The second type of inguinal hernia is the direct inguinal hernia or sometimes called an acquired inguinal hernia. This type of hernia develops from a tear or weakness in the floor of the inguinal canal. The tear can be result of the sudden accident or chronic over use. Chronic cough, difficulty with urination because of an enlarged prostate or chronic constipation are also major risk factors. Smokers have weak connective tissue and are also at increased risk for direct inguinal hernias. The direct inguinal hernia develops in the floor of the inguinal canal medial to the epigastric vessels, because this is the weakest part of the abdominal wall. On physical examination, the bulge does not follow the spermatic cord, but comes straight out of medial aspect of the inguinal floor.
Type 3: Femoral Hernia
The third type of inguinal hernia is called a femoral hernia. It occurs from a defect that is deep to the inguinal ligament. On physical examination, the bulge often appears as if it is high on the anterior medial aspect of the thigh. The bulge is usually small, and thus it can be difficult to palpate. It is a common hernia in women.
It’s possible for some patients to have a combination of the various types of hernias.
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