Difference Between Direct and Indirect Inguinal Hernia

Key Difference – Direct vs Indirect Inguinal Hernia
 

Direct and Indirect Inguinal Hernia are two types of inguinal hernias which are defined by their relationship to the inferior epigastric vessels. The key difference between direct and indirect inguinal hernia is that the indirect inguinal hernia can be present from birth whereas direct inguinal hernia occurs through a weak point in the floor of the inguinal canal. Inguinal hernia is a condition where abdominal contents protrude through a weak point of the abdominal wall in the groin region. Indirect inguinal hernia occurs through a weakness present from birth at the entrance of the inguinal canal, which is the pathway of the descent of testis from the abdominal cavity into the scrotum. Direct inguinal hernia is less common than indirect inguinal hernia.

What is Indirect Inguinal Hernia?

Indirect inguinal hernia sac has a narrow neck formed by the internal orifice of the inguinal canal. Even though this orifice tends to close after the birth, in certain people, it remains open. This makes a weak point on the abdominal wall surrounding the compact abdominal contents. In a situation of increased pressure within the abdominal cavity such as coughing, straining, or sneezing, the contents of the abdomen are pushed into this narrow space. The patient will feel a bulk over the groin which becomes prominent during standing and coughing. Sometimes, the bowel can descend into the scrotum causing enlargement of the scrotum, and that causing sexual difficulties and social embarrassment.

What is Direct Inguinal Hernia?

Direct inguinal hernia is a condition where abdominal contents protrude into the inguinal canal through a weakness of its wall. Having a larger orifice direct inguinal hernia may remain unnoticed for a long time. This type of a hernia usually occurs with the weakening of the abdominal wall musculature as a part of general emaciation when associated with conditions that increase the abdominal pressure such as weight lifting or a long-standing cough.

What is the difference between Direct and Indirect Inguinal Hernia?

Definition of Direct and Indirect Inguinal Hernia

Indirect Inguinal Hernia: Indirect inguinal hernia sac has a narrow neck formed by the internal orifice of the inguinal canal.

Direct Inguinal Hernia: Direct inguinal hernia is a condition where abdominal contents protrude into the inguinal canal through a weakness of its wall.

Features of Direct and Indirect Inguinal Hernia

 Age Groups

Indirect Inguinal Hernia: Indirect inguinal hernia is common below the age of 40.

Direct Inguinal Hernia: Direct inguinal hernia is common above the age of 40.

Presentation

Indirect Inguinal Hernia: Indirect inguinal hernia can present as enlargement of the scrotum.

Direct Inguinal Hernia: Direct inguinal hernia can present as a soft bulge in the groin.

Complication Rate

Indirect Inguinal Hernia: Indirect inguinal hernia can lead to bowel entrapment, loss of blood supply, and rupture.

Direct Inguinal Hernia: In direct inguinal hernia, the above complications are rare.

Surgical Repair

Indirect Inguinal Hernia: Indirect inguinal hernia repair needs closure of the internal inguinal ring as an essential step.

Direct Inguinal Hernia: Direct inguinal hernia repair needs strengthening of the abdominal wall musculature by using a polypropylene mesh

Recurrence rate

Indirect Inguinal Hernia: Indirect inguinal hernia has a less recurrence rate after surgical repair.

Direct Inguinal Hernia: Direct inguinal hernia can recur even after a successful surgical closure.