Fig. 3.1
Template created for use in classifying incisional abdominal wall hernias (according to EHS classification) (Adapted with permission from Muysoms et al. [14])
According the Location
1.
Vertical
1.1.
Midline supra- or infraumbilical
1.2.
Midline including navel (right or left)
1.3.
Paramedian (right or left)
2.
Transverse infraumbilical
2.1.
Supra- or infraumbilical (right or left)
2.2.
Cross the midline or not
3.
Oblique
3.1.
Supra- or infraumbilical (right or left)
4.
Combined (midline mean + oblique, midline + paraostomal +, etc.)
According to Size
1.
Small (<5 cm wide or long)
2.
Medium (5–10 cm wide or long)
3.
Large (>10 cm wide or long)
According to the Recurrence
1.
Primary
2.
Relapsed (1, 2, 3, etc. With the type of hernioplasties: suture, prosthesis, or both)
According to the Situation with the Ring
1.
Reducible
2.
Irreducible with or without obstruction
According to the Symptoms
1.
Symptomatic
2.
Asymptomatic
Other Hernias
Hernias of the abdominal wall of uncommon location can occur in less than 2 % of hernias. These are discussed in the sections that follow.
Lumbar Hernia
Lumbar hernias have been classified as:
1.
Congenital: Grynfeltt when they appear in the upper triangle of the lumbar region and Petit when they appear in the lower triangle, comprising 10 % of lumbar hernias
2.
Traumatic: with a rate of 25 %
3.
Incisional: representing between 50 and 60 %, associated usually with lumbotomy-urological surgery and orthopedic surgery and large portions of iliac crest bone graft
4.
Spontaneous: making up the remaining percentage and related to neurological disorders in the region [6]
Obturator Hernia
Obturator hernias are exceptional entities, and most surgeons will see very few throughout their careers. They consist of the protrusion of abdominal contents through the orifice shutter of the pelvis, preferably on the right side. They appear more frequently in older, thin, and multiparous women. The incidence is higher in Asian countries, so the older series are by Chinese and Japanese authors [7].
Spigelian Hernia
The Spigelian hernia is the most frequent of the rare hernias [8]. It is formed in the area of the Spiegel, the largest portion of the transverse and oblique minor muscles between the semilunar line (transition of muscle fibers to aponeurotics of the transverse muscle) and the lateral edge of the sheath of the rectum.
Parastomal Hernias
Parastomal hernias are incisional hernias associated with a stoma in the abdominal wall. Parastomal hernias are classified into four subtypes:
1.
Subcutaneous type with a subcutaneous hernia sac
2.
Interstitial type with a hernia sac within the muscle and the largest layers of the abdomen
3.
Parastomal type with the bowel prolapsed through the circumferential hernia sac surrounding the stoma
4.
Intrastomal type in ileostomies with a hernia sac between the intestinal wall and the intestinal layer everted
Perineal Hernias
Perineal hernias are the protrusion of abdominal viscera between the muscle and aponeurosis that form the floor of the pelvis. They are divided into primary, hernias that occur spontaneously, and secondary, hernias or perineal ruptures that occur after operations (prostatectomy, abdominopelvic amputation) that debilitate the pelvic floor.
Sciatic Hernia
These hernias are also called gluteal hernias. They are the major and minor protrusion through the sciatic holes. They are the least frequent of all the external abdominal hernias. They appear in both genders alike, usually in older people.
Related posts:
Emergency Laparoscopic Surgery of the Abdominal Wall
Basic Concepts in Laparoscopic Hernia Repair
Laparoscopic Ventral Hernia Repair
Prostheses Fixation During Laparoscopic Inguinal Hernia Repair
Current Advances and New Frontiers in Laparoscopic Hernia Repair
Laparoscopic Approach in Other Hernias: Subcostal, Xiphoid, Lumbar, Suprapubic, Parastomal, and Spigelian
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