A 35-year-old male athlete presents with groin pain, bulge medial to the inferior epigastric vessels, and a positive cough impulse at the superficial inguinal ring. At laparoscopy, a peritoneal bulge is confirmed medial to the inferior epigastric vessels in the Hesselbach triangle. Using the European Hernia Society (EHS) classification, which type is this hernia?

• A EHS Type M (medial/direct inguinal hernia) ✓
• B EHS Type L (lateral/indirect inguinal hernia)
• C EHS Type F (femoral hernia)
• D EHS Type LC (combined/pantaloon hernia)

Explanation

The EHS classification for inguinal hernias uses: Type L (lateral) for indirect hernias through the deep inguinal ring lateral to inferior epigastric vessels; Type M (medial) for direct hernias in Hesselbach's triangle medial to inferior epigastric vessels; Type F (femoral) for hernias through the femoral canal; and Type LC or ML for pantaloon/combined hernias. This patient's hernia is medial to the inferior epigastric vessels in Hesselbach's triangle — consistent with a direct (medial, Type M) inguinal hernia. The EHS further sub-classifies by size: M1/L1 (<1.5 cm), M2/L2 (1.5-3 cm), M3/L3 (>3 cm).

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.