Current classification of inguinal hernia: time to correct, update and change?

Abstract

Repair of an inguinal hernia is a commonly performed surgical procedure. Current classifications
are predominantly attributable to Hesselbach, who in the 19th Century described the anatomy
of the inguinal region and the relationship of inguinal hernia to the inferior epigastric vessels.
However largely due to the dynamic visualization of inguinal anatomy at video-surgery, our better
understanding of inguinal anatomy is facilitated; consequently, we believe that the inferior epigastric
vessels have a coincidental anatomical relationship and have no significant causal relationship to
groin herniation. Furthermore, we believe the current classification, using the terms ‘direct’ and
‘indirect’ are anatomically incorrect. It is our opinion that such classification should be abandoned in
favour of a simplified system which reflects our enhanced appreciation of the anatomy.