An updated traditional classification of inguinal hernias

Abstract

The traditional classification of inguinal hernias is the most widely used system today; however, it does not categorize all inguinal hernias nor their levels of complexity. The named systems of Gilbert, Nyhus, and Schumpelick are reviewed, and their common features are analyzed. A simple updating of the traditional classification along with the use of common modifiers creates a system that is all-inclusive and easy to use for data registries. The traditional classification of inguinal hernias (indirect, direct, and femoral) has withstood the test of time for almost 150 years. In this interval, inguinal hernia repairs have experienced significant evolution from simple ligation of the sac or suturing of the muscular defect to improved primary tissue repairs (e.g., Bassini, McVay, Shouldice) based upon better anatomic principles. Also during the past 30 years, two major revolutions in operative repairs have occurred. First, there is the use of mesh and, second, its placement laparoscopically. As a consequence, hernia surgeons today must choose among multiple competing operative techniques. No one operative technique has proven to be best for all inguinal hernias. Also different levels of complexity and severity exist among inguinal hernias, and thus it is essential that we accurately classify the various inguinal hernias, such that we surgeons can provide the best operative solution for each patient. As Fitzgibbons [1] states, “The primary purpose of a classification for any disease is to stratify for severity so that reasonable comparisons can be made between various treatment strategies.”