A hernia classification is done to serve as a blueprint for hernia surgeons to identify the type of hernia and determine the best treatment options to treat it.
Doctors can understand how the hernia affects the body and determine the appropriate treatment method that will help repair the hernia without causing any complications. It also assists in evaluating some factors, like
- Complication rate,
- Recovery period,
- Recurrence rate, etc.
There are several surgeons who have classified inguinal hernia. Among them, Gibert’s classification of hernias is the one that most doctors refer to. In 1989, Gilbert classified inguinal hernias into 5 types.
Four years later in 1993, Rutkow and Robbins further added two types into this classification. In this article, we will look into type 7 of Gilbert’s classification of hernia.
What is the Type 7 of Gilbert's hernia?
Gilbert classified inguinal hernias based on three factors that he observed intraoperatively. They are
- The size of the internal ring,
- The integrity of the floor, and
- The presence or absence of hernia sac.
The two extra types of hernia that Rutkow and Robbins added to Gilbert’s classification of hernia are Pantaloon hernias and Femoral hernias.
Among all the types of hernias in Gilbert’s classification, femoral hernia is the one that is most commonly found in women. It happens when a loop of the intestine bulges through the lower abdominal wall near the thigh area.
Femoral hernia is a rare type of hernia. Most hernias affecting the groin area are inguinal, and only some are femoral hernias. Though most femoral hernias are asymptomatic and harmless, sometimes they can lead to complications like obstruction of blood flow and strangulation.
What are the causes of femoral hernia?
Most times, there are no specific causes for femoral hernia or any other type of hernia. Some prominent causes of femoral hernias are given below.
- Chronic cough that puts pressure on your body
- Chronic constipation that causes muscle strain while using the restroom
- Weak abdominal muscles due to childbirth
- Obesity
- Previous surgeries in the lower abdomen
- Heavy lifting or doing strenuous activities
- Difficult urination due to enlarged prostate
How is it different from the other 6 types of Hernias?
Femoral hernias are a bit different from other types of hernias in Gilbert’s classification. Below are some factors that differentiate it from the others.
- A femoral hernia is less common than inguinal hernia
- Femoral hernias are more common in women than in men
- A femoral hernia has a 50% chance of becoming serious and resulting in strangulation
- A femoral hernia has the risk of easily being mixed on examination.
What are the other 6 Types of Gilbert's Hernias?
As mentioned at the beginning of the article, Gilbert classified inguinal hernia into five types, and Rutkow and Robbins extended it by adding 2 more types to the classification. Femoral hernia is the seventh type. Now, let’s look at the first six types of Gilbert’s hernia.
Indirect hernias
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.
- The peritoneal sac passes 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.
- The peritoneal sac passes through a large, distorted, and dilated deep internal ring of two or more fingerbreadths (more than 4 cm.)
- Part of the posterior wall is defective.
- Examples: Sliding Inguinal hernia and scrotal hernia.
Direct 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 there are 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 posterior wall defect of no more than one fingerbreadth (less than 2 cm.)
- No peritoneal sac passing through.
Direct & indirect hernia
Type 6: Pantaloon hernia
- A combination of direct and indirect hernia.
- It is also called Romberg’s hernia, saddlebag hernia, or dual/double hernia.
- The hernial sac pushes through both sides of the inferior epigastric vessels.
Conclusion
The Gilbert classification of hernias has been a guiding tool for several surgeons to identify the type of inguinal hernia and provide the best course of treatment for the patients.
If you experience symptoms similar to hernia and suspect you might have it, don’t delay and visit a laparoscopic Hernia surgeon immediately and diagnose the issue.
