Beruflich Dokumente
Kultur Dokumente
DOI 10.1007/s10029-007-0198-3
R E VI E W
Introduction
Many diVerent groin hernia classiWcations are available. Most of them are complex and therefore diYcult
to remember. The result is infrequent systematic use in
A. N. Kingsnorth
Peninsula Medical School, Level 7,
Derriford Hospital, Plymouth, PL6 8DH, UK
V. Mandala
Department of General and Emergency Surgery,
Villa SoWa, CTO Hospital, Palermo 90015, Italy
J. P. Palot
Service de Chirurgie Generale et Digestive,
Hopital Robert-Debre-CHU, 51092 Reims, France
V. Schumpelick
Department of Surgery, Medical Faculty,
University Hospital, Rheinish-Westphalian
Technical University (RWTH), Pauwelsstrasse 30,
52074 Aachen, Germany
R. K. J. Simmermacher
Department of Surgery, University Hospital,
3584X Utrecht, The Netherlands
M. H. Pascual
Department of Surgery, 12 de Octubre
University Hospital, Madrid, Spain
R. Stoppa
Amiens, France
A. Hoeferlin
Katholisches Klinikum Mainz SHK,
Chirurgische Abteilung, Hildegardstr. 2,
55131 Mainz, Germany
J. B. Flament
Department of Surgery and Anatomy,
Reims University, Service de Chirurgie Generale,
Hopital Robert-Debre-CHU, 51092 Reims, France
123
Hernia
Results
All the diVerent classiWcations have some drawbacks.
Table 1 illustrates most of the currently available hernia classiWcations. The Nyhus classiWcation is one of
the most frequently used classiWcations, but is not so
easy to remember [1], like the Stoppa classiWcation,
which is derived from the Nyhus classiWcation, with
special attention to the aggravating factors [2]. The
Bendavid type, staging, dimension (TSD) classiWcation
is very complex, with 20 diVerent subtypes [3]. Moreover, some of the available classiWcations, such as the
Gilbert classiWcation [4] lack the description of femoral
hernias or combined hernias (e.g. pantaloon hernia). A
simple and easy-to-remember classiWcation is the
Aachen classiWcation [5], making a distinction between
Discussion
Hernia classiWcations are useful for pre- or intra-operative description of the anatomy and size of a groin hernia. This objective description is a prerequisite in the
case of tailored surgery, e.g. suture repair versus mesh
repair in small indirect inguinal hernias without attenuTable 2 The EHS groin hernia classiWcation
Direct
Fem
Rec
Gilbert
Stoppa
Nyhus
Bendavid TDS
Alexandre
TOS
Schumpelick
Corcione
Cost
Porrero
123
1
1
I
I
1
3
2
II
IIIb
1
2 3
9
L cm
0
; cm
L I L II L III
1
1
2
3
1
2
3
4
3
IIIa
II
2
MI
2
1
5
5
4
IV
V
R
II
III R
3
4
IIIc
III IV
3
4
F
3
Hernia
123
Hernia
References
1. Nyhus LM, Klein MS, Rogers FB (1991) Inguinal hernia.
Curr Probl Surg 28:403450
2. Stoppa R (1998) Groin hernias in the adult. In: Chevrel J-P
(eds) Hernias and surgery of the abdominal wall. 2nd edn.
Springer, Berlin, pp 175178
3. Bendavid R (1995) The TSD classiWcation: a nomenclature
for groin hernias. In: Schumpelick V, Wantz GE (eds) Inguinal hernia repair. Karger, Basel, pp 4855
4. Gilbert AI (1989) An anatomical and functional classiWcation
for the diagnosis and treatment of inguinal hernia. Am J Surg
157:331333
123