The Nyhus classification of groin hernias (1991) categorizes inguinal hernias for laparoscopic repair planning. Which type corresponds to a large direct inguinal hernia with a dilated internal ring?

• A Type I — indirect, normal internal ring
• B Type II — indirect with slightly enlarged ring
• C Type IIIc — femoral hernia
• D Type IIIb — direct hernia with attenuated floor ✓

Explanation

The Nyhus classification: Type I = indirect with normal ring (pediatric); Type II = indirect with slightly enlarged ring; Type IIIa = direct inguinal hernia (floor defect); Type IIIb = large indirect hernia with dilated internal ring or combined (pantaloon) defect; Type IIIc = femoral hernia; Type IV = recurrent hernias. The question describes a large direct inguinal hernia with a 'dilated internal ring' which matches IIIb (combined or pantaloon hernia with both components). Type IIIa is purely direct. This distinction guides laparoscopic TEP/TAPP mesh placement planning.

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.