Direct vs. Indirect Hernia

  • Medical Author:
    Jerry R. Balentine, DO, FACEP

    Dr. Balentine received his undergraduate degree from McDaniel College in Westminster, Maryland. He attended medical school at the Philadelphia College of Osteopathic Medicine graduating in1983. He completed his internship at St. Joseph's Hospital in Philadelphia and his Emergency Medicine residency at Lincoln Medical and Mental Health Center in the Bronx, where he served as chief resident.

  • Medical Editor: John P. Cunha, DO, FACOEP
    John P. Cunha, DO, FACOEP

    John P. Cunha, DO, FACOEP

    John P. Cunha, DO, is a U.S. board-certified Emergency Medicine Physician. Dr. Cunha's educational background includes a BS in Biology from Rutgers, the State University of New Jersey, and a DO from the Kansas City University of Medicine and Biosciences in Kansas City, MO. He completed residency training in Emergency Medicine at Newark Beth Israel Medical Center in Newark, New Jersey.

Direct vs. indirect hernia facts

  • Approximately 800,000 hernia surgeries are performed every year in the U.S.
  • Inguinal hernias are diagnosed by physical examination.
  • Surgery (laparoscopic or open technique) is the standard treatment for a hernia.
  • Hernia compilations can range from minor pain to a need for emergency surgery.

What are inguinal hernias?

Inguinal hernias are the most common type of hernias. They occur when tissues protrude through a spot in the abdominal muscles. Frequently, this tissue will be part of the intestine.

Inguinal hernias are not dangerous itself but can lead to significant complications especially if the intestinal tissue loses its blood supply. Usually, the hernia can be pushed back in or even slides back when the patient lays down. If the hernia cannot be pushed back in, it is considered incarcerated (the contents of the hernia are trapped). This will usually lead to severe pain, as well as nausea and vomiting. If the blood supply is cut off, the hernia is considered strangulated. A strangulated hernia is life-threatening and requires immediate surgery.

Inguinal hernias are divided into direct and indirect hernias.

What is a direct hernia?

These inguinal hernias are usually caused by weakness in the muscle of the abdominal wall. The weakness can be due to an acute event (heavy lifting) or slowly develop over time.

Most commonly, this hernia is found in adult males.

What is an indirect hernia?

An indirect hernia is caused by a birth defect in the abdominal wall.

What are causes and risk factors of direct and indirect hernias?

The hernias usually appear after increased abdominal pressure, such as straining or lifting a heavy object. Often they are linked to a weak spot in the abdominal wall that can be present since birth or secondary to abdominal surgery, injuries, or develop over time.

In men, the weakness usually is found in the inguinal canal that leads down into the scrotum.

Risk factors for inguinal hernias are older age, obesity, being male, and having a family history of a hernia. Chronic cough and pregnancy are also risk factors.

Hernia Treatments

Surgical repair is indicated for most hernias that require treatment. All irreducible hernias need immediate evaluation because of the possibility of becoming strangulated. In some situations, surgery may be delayed or unable to be performed. Your doctor may prescribe trusses or belts to help keep the hernia reduced. People with hernias and those that have had surgical repair of hernias should avoid heavy lifting and other activities that cause high intra-abdominal pressure.

What are signs and symptoms of direct and indirect hernias?

A bulge is usually visible in your inguinal area (groin). This bulge might become more obvious on standing or when lifting or coughing (straining). There might be pain or discomfort in the groin. If the hernia pushed into your scrotum, pain and swelling around the testicle will be present.

In newborns, the hernia might be visible when the child cries or coughs.

How do health care professionals diagnose hernias, and what is the treatment for direct and indirect hernias?

Your doctor can usually diagnose an inguinal hernia by physical examination alone. A bulge will be apparent in your groin while standing. Coughing will help show the bulge.

Should the hernia not be readily visible, your doctor might order a CT scan or MRI.

If the hernia is not painful and not too large, you can choose to watch it without any specific therapy. Depending on your lifestyle and the discomfort level, you might choose surgery to fix the hernia.

An enlarging hernia, or significant pain, will usually require surgery to alleviate the symptoms.

Any hernia that cannot be reduced (pushed back in) will require surgery.

Hernia repair can take place in two different ways: open hernia repair and laparoscopic repair.

The open procedure requires an incision, pushing the hernia back in, and then repairing the weak area.

During the laparoscopic procedure, the surgeon will repair the hernia via several small incisions and guidance by a small camera inserted through one of the incisions.

What is the prognosis for direct and indirect hernias?

The repairs of inguinal hernias are usually successful with minimal complications and reoccurrences.

Is it possible to prevent direct and indirect hernias?

In many cases, it is impossible to prevent inguinal hernias as the weakness in the abdominal wall is present since birth. Avoiding straining, heavy lifting, and treating chronic cough can be helpful preventive measures.

REFERENCE:

Bhandarkar, Deepraj S., Manu Shankar, and Tehemton E. Udwadia. "Laparoscopic surgery for inguinal hernia: Current status and controversies." J Minim Access Surg 2.3 September 2006: 178-186.

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Reviewed on 11/30/2017
References
REFERENCE:

Bhandarkar, Deepraj S., Manu Shankar, and Tehemton E. Udwadia. "Laparoscopic surgery for inguinal hernia: Current status and controversies." J Minim Access Surg 2.3 September 2006: 178-186.

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