A hernia occurs when a part of your body pushes through and bulges against the muscle and surrounding tissue that contains it. It is prominent in the abdomen or groin areas.
There are several types of hernias that are distinguished based on their type and location. One such hernia is inguinal hernia. Inguinal means “in the groin.”
There are several types of classifications for inguinal hernia. One such classification is the Nyhus classification of hernia. This classifies hernia based on their type, size, and location in the body.
Now, let’s dig deeper into this classification and learn more about the types of hernia.
What is the Nyhus classification of Hernia?
Nyhus classification is based on the types and surgical methods for inguinal hernias. In 1993, Lloyd Milton Nyhus classified inguinal hernias based on their anatomical features (size, type, and location in the human body).
He offered surgical procedures for each kind of hernia, concentrating on the functions of the internal ring and the posterior inguinal wall in each case. This has made it easier for surgeons to repair strangled inguinal hernias.
Nyhus classification of hernia
Nyhus classified inguinal hernia into four types. Below are the detailed explanations for each type.
Type 1: Indirect Hernia with an internal inguinal ring of Normal Size
This kind of indirect hernia is most common in infants, children, and young people. Here, the inguinal ring or the deep ring is intact and of normal size.
Type 2: Indirect Hernia with dilated internal ring
This is also an indirect hernia where the internal or deep ring is enlarged but without impingement on the floor of the inguinal canal. It does not extend to the scrotum.
Here, the posterior wall is intact, and the inferior deep epigastric vessels are not displaced.
Type 3: Posterior inguinal wall defect
The posterior wall also has defects in this type of hernia. If the posterior wall is defective, patients will experience a variety of hernias.
Type 3A:
Direct hernia. Here, the size of the hernia is not taken into account. Only the posterior wall defect counts.
Type 3B:
An indirect hernia, where the internal ring is enlarged enough to reach the posterior inguinal wall. Some examples of this type are the scrotal hernia, the pantaloon hernia, and the sliding hernia ( Sliding Inguinal Hernia).
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- A scrotal hernia is a full hernia in which the innards of the hernia or the loops of the hernia go to the base of the scrotum.
- Pantaloon hernia, also called Romberg’s hernia, Dual hernia, or saddlebag hernia, is a combination of direct and indirect hernia where the hernial sac pushes through both sides of the inferior epigastric vessels.
- Hernia-en-glisade or sliding hernia. It is a type of indirect hernia that primarily affects males and occurs when the viscous tissue becomes a component of the hernial sac. When you try to strain and strip this wall, you run the risk of causing damage to the material. This is a very dangerous situation.
Type 3C:
Femoral hernia is most commonly found in females. It is where a loop of the intestine bulges through the abdominal wall in the lower abdomen near the thigh region.
Type 4: Recurrent Hernia
A recurrent hernia is when the hernia appears near or at the location of a previously treated hernia. This appears due to insufficient surgical treatment of the previous hernia or the recurrence of the same event that produced the original hernia. It is of four types:
- Type 4A: Direct recurrent hernia
- Type 4B: Indirect recurrent hernia
- Type 4C: Femoral recurrent hernia
- Type 4D: A combined hernia, which is a combination of types 4A, 4B, and 4C.
Conclusion
The Nyhus classification of hernia gives surgeons a clear classification of the types of inguinal hernia and the proper treatment method for each of them. Identifying the hernia at an early stage and undergoing laparoscopic surgery with the Best Hernia Surgeon to repair it is advised to prevent any serious complications.
FAQs
By severing the layers of the abdominal wall above the internal ring and gaining access to the preperitoneal area, posterior repair (also known as iliopubic tract repair and Nyhus procedure) is carried out.
Here are some of the types of hernias.
- Inguinal hernia (inner groin)
- Incisional hernia (resulting from incisions or surgical cuts)\
- Femoral hernia (outer groin)
- Umbilical hernia (belly button)
- Hiatal hernia (upper stomach)
Pantaloon hernia is a very rare type of hernia, especially in women, and Nyhus categorizes them as Type 3B. It can be diagnosed by identifying two separate swellings in the inguinal region, one medial and one lateral to the inferior epigastric vessels.
With the exception of the women in their 40s, for whom incisional hernias predominate, inguinal hernias are the most common hernia type in females. The probability of emergency presentation is highest in elderly females, particularly those with femoral hernias.
