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Gilbert classification of hernia

Gilbert Classification of Hernia

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An inguinal hernia occurs when the organs push through and bulge against the weak muscles of the abdomen.

An effective classification of the types of inguinal hernia can serve as an anatomical blueprint that can help doctors evaluate its functions and features. This can assist doctors in determining the appropriate treatment method for each type of hernia.

Gilbert, in 1989, classified inguinal hernia into 5 types based on their features. Rutkow and Robbins further expanded this classification in 1993 and added two more types of inguinal hernia. In this article, let’s look at all 7 types of Hernias in the Gilbert classification.

What is the Gilbert classification of Hernia?

Gibert classified inguinal hernias into five types in 1989 to give surgeons an easier way to analyze each hernia and use the best surgical method.

The 5 Types of Hernia's

Gilbert classified inguinal hernia based on

  • The size of the internal ring,
  • The presence or absence of the peritoneal sac and
  • The integrity of the posterior wall.

Type 1: Snug internal ring, intact canal floor

  • Indirect inguinal hernia.
  • Peritoneal sac passing through an intact deep internal ring of less than one fingerbreadth (less than 1.5 cm.)
  • Intact posterior wall.

Type 2: One finger breadth internal ring, intact canal floor

  • Indirect inguinal hernia.
  • Peritoneal sac passing through a moderately dilated deep internal ring of one fingerbreadth (1.5– 4 cm).
  • Intact posterior wall.
  • Example: Bubonocele hernia.

Type 3: Two fingerbreadth internal ring, defective canal floor

  • Indirect inguinal hernia.
  • Peritoneal sac passing through a large dilated and distorted deep internal ring of two or more fingerbreadths (more than 4 cm.)
  • Part of the posterior wall is defective.
  • Examples: Sliding hernia (Sliding Inguinal Hernia) and scrotal hernia.

Type 4: Entire canal floor defective, no peritoneal sac anterior to canal floor, intact internal ring

  • Direct inguinal hernia.
  • Intact deep internal ring.
  • The entire posterior wall is defective, or multiple defects in the posterior wall.
  • No peritoneal sac passing through.

Type 5: Diverticulum defect admitting no more than one finger, internal ring intact

  • Direct inguinal hernia.
  • Intact deep internal ring.
  • Diverticular defect of the posterior wall of no more than one fingerbreadth (less than 2 cm.)
  • No peritoneal sac passing through.

Gilbert's classification of Hernia Expanded from 5 types to 7

Gilbert had classified Hernia into 5 types, Four years later it was Expanded to 7 Types. 

Who expanded the Gilbert classification of hernia?

The Gilbert classification of hernia was then expanded by Rutkow and Robbins in 1993. They added two more types of hernia to this classification.

What are the 2 more types of Hernias?

Type 6: Pantaloon hernia

Pantaloon Hernia is 

  • A combination of direct and indirect hernia.
  • Also called Romberg’s hernia, dual/double hernia, or saddlebag hernia.
  • Both sides of the inferior epigastric vessels are pushed through by the hernial sac.

Type 7: Femoral hernia

This type of Hernia which is widely known as the Type 7 Gilbert Hernia

  • Most commonly found in females.
  • A loop of the intestine bulges through the abdominal wall in the lower abdomen near the thigh.

What is Direct Hernia And Indirect Hernia?

The anatomical location of the hernial sac is what distinguishes indirect from direct inguinal hernias.

Direct hernias are openings in the lower abdomen that protrude through the posterior (rear) wall of the inguinal canal on either side of the groin. At the tip of the inguinal canal, indirect hernias protrude through the inguinal ring. So it is advised to consult the Best Hernia surgeon for an effective treatment. 

Conclusion

 There are other classifications for Hernias such as the Nyhus Classification but standing out from others The Gilbert classification of hernia gives surgeons a clear classification of the types of inguinal hernia and the proper treatment method. Identifying the hernia early and undergoing surgery to repair it is advised to prevent serious complications.

FAQs

In 1993, Rutkow and Robbins added two types (Type 6 and Type 7) of inguinal hernia to the 5-types Gilbert classification of hernia. The type 7 inguinal hernia is the femoral hernia.

Two adjacent hernia sacs in the inguinal and/or femoral areas on the same side are combined to form a pantaloon hernia. Therefore, both sides of the inferior epigastric vessels have the sacs. Pantaloon hernia is a combination of direct and indirect hernias.

The deadly triangle, often known as the triangle of doom, is a triangular area bounded by the vas deferens, the testicular arteries, and the peritoneal fold during a laparoscopic inguinal hernia repair. The external iliac artery and vein are located within its limits.

Dr. K. Amilthan MBBS., MS., FMAS., FALS.

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