Epidemiological and Clinical Characteristics of Inguinal Hernia Patients at a Tertiary Care Hospital in Khulna City

To investigate which type of hernia that has the highest risk of a recurrence after a primary Lichtenstein repair. Male patients operated on with a Lichtenstein repair for a primary direct or indirect inguinal hernia and with a TEP for a later recurrence, with both operations recorded in the Swedish Hernia Register (SHR), were included in the study. The study period was 1994-2014. Under the study period, 130,037 male patients with a primary indirect or direct inguinal hernia were operated on with a Lichtenstein repair. A second operation in the SHR was registered in 2236 of these patients (reoperation rate 1.7%). TEP was the chosen operation in 737 in this latter cohort. The most likely location for a recurrence was the same as the primary location. If the recurrences change location from the primary place, we recognized that direct hernias had a RR of 1.51 to having a recurrent indirect hernia compared to having a direct recurrence after an indirect primary hernia repair. Recurrent hernias after Lichtenstein are more common on the same location as the primary one, compared to changing the location.

Recurrence patterns of direct and indirect inguinal hernias in a nationwide population in Denmark

Objective To summarize the clinical characteristics of recurrent inguinal hernia and investigate the choice of laparoscopic surgical procedures. Methods The clinical data of 330 patients with recurrent inguinal hernia (352 inguinal hernias) who underwent laparoscopic inguinal hernia repair (LIHR) at the Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine between January 2001 and December 2014 were retrospectively analyzed. The surgical procedures including transabdominal preperitoneal (TAPP) approach, total extraperitoneal (TEP) approach and intraperitoneal onlay mesh (IPOM) approach were selected and performed by doctors in the same team. Observed indicators included recurrent sites of previous surgery, repair methods, surgical procedures and clinical efficacies of this surgery. Patients were followed up by telephone interview and outpatient examination up to June 2015. The follow-up included the recurrence and postoperative complications.Measurement data with normal distribution were presented as±s, skew distribution data were described as M (range), and count data were analyzed using chi-square test. Results (1)Recurrent sites: of 352 recurrent inguinal hernias, 186 were detected in direct hernia region, 111 in indirect hernia region, 6 in femoral hernia region and 49 in compound hernia region. Among 125 recurrent inguinal hernias after suture repair, 44 were detected in direct hernia region, 48 in indirect hernia region, 2 in femoral hernia region and 31 in compound hernia region. Among 110 recurrent inguinal hernias after mesh-plug repair, 85 were detected in direct hernia region, 16 in indirect hernia region and 9 in compound hernia region. Among 61 recurrent inguinal hernias after patch repair, 37 were detected in direct hernia region, 16 in indirect hernia region, 3 in femoral hernia region and 5 in compound hernia region. Among 36 recurrent inguinal hernias after preperitoneal repair, 19 were detected in direct hernia region, 12 in indirect hernia region, 1 in femoral hernia region and 4 in compound hernia region. Among 14 recurrent inguinal hernias after high ligation of hernial sac, 1 was detected in direct hernia region and 13 in indirect hernia region. Six recurrent inguinal hernias after sclerosing agent injection were detected in indirect hernia region. Incidence of direct hernia in recurrent inguinal hernias was 52.84%(186/352), which was significantly different from 23.70%(998/4 211) in primary inguinal hernias (χ2=171.397, P<0.05). Incidence of direct hernia in recurrent inguinal hernias with implanted patches was 68.12%(141/207), which was significantly different from 31.03%(45/145) in primary inguinal hernias without implanted patches (χ2=47.052, P<0.05). (2)Repair methods: repairing myopectineal orifice was applied to recurrent inguinal hernias without implanted patches and after patch repair, with a ratio of fixed/unfixed patches of 82/124. Repairing myopectineal orifice or hernia defects was applied to recurrent inguinal hernias after mesh-plug repair and preperitoneal repair, with a ratio of fixed/unfixed patches of 133/13. There was significant difference in the ratio of fixed patch between the 2 repair methods (χ2=94.552, P<0.05). (3)Surgical procedures: of 352 recurrent inguinal hernias, 288 underwent TAPP approach, 50 underwent TEP approach and 14 underwent IPOM approach. TAPP approach and TEP approach were performed in 91 and 34 recurrent inguinal hernias after suture repair, TAPP approach and IPOM approach in 108 and 2 recurrent inguinal hernias after mesh-plug repair, TAPP approach and TEP approach in 46 and 15 recurrent inguinal hernias after patch repair, TAPP approach and IPOM approach in 24 and 12 after preperitoneal repair, TAPP approach and TEP approach in 13 and 1 recurrent inguinal hernias after high ligation of hernial sac and TAPP in 6 recurrent inguinal hernias after sclerosing agent injection. (4)Clinical efficacies: 330 patients underwent successfully laparoscopic surgery without conversion to open surgery and analgesics. The operation time, pain scores at postoperative day 1, the ratio of patients restoring unrestricted activities within 2 weeks and duration of postoperative hospital stay in 330 patients were (40±13)minutes (range, 15-100 minutes), 2.4±1.1 (range, 0.6-7.3), 99.70%(329/330) and (1.7±1.4)days (range, 1.0-9.0 days), respectively. Among 35 patients with complications, 1 patient with recurrent hernia after patch repair received reoperation of intestinal canal repair due to damnify of intestinal canal during TEP approach, other complications including 22 seroma, 8 urinary retention, 3 temporary nerve paresthesia and 1 paralytic ileus, and were cured by symptomatic treatment. All the patients were followed up for a median time of 58 months (range, 6-174 months). Conclusions Recurrent inguinal hernias are found frequently in the direct hernia region, with a higher ratio of direct hernias with implanted patches. According to intraoperative conditions, repairing myopectineal orifice or hernia defects can be selected during LIHR, and a choice of TAPP approach and TEP approach depends on previous surgical approach, gap of implanted patches and doctors' experiences. IPOM approach can be served as an alternative for TAPP approach. Key words: Inguinal hernia, recurrent; Therapy; Laparoscopy

Hernia recurrence is an important complication following inguinal hernia repair. Primary closure of ventral hernia defects laparoscopically has been shown to reduce the risk of recurrence and seroma formation. The results for ventral hernias may potentially be applied to direct inguinal hernias. Our aim was to evaluate the value of primary closure of direct defects during laparoscopic inguinal hernia mesh repair in reducing the incidence of early recurrence. A retrospective, single-center cohort study was conducted on cases performed from August 2016 to February 2018. Patients with direct inguinal hernias undergoing elective laparoscopic mesh repair were included. When performed, the direct hernia defect was primarily closed with extracorporeal non-absorbable interrupted sutures followed by standard placement of a lightweight mesh covering myopectineal orifices. Early recurrence was defined as occurring within 1year of surgery. A total of 75 direct inguinal hernias in 53 patients who underwent surgery and completed at least 1year of follow-up were analyzed. The mean age of patients was 63years (range 44-82years); with majority of patients being male (98.1%). There were no significant differences observed between the two patient populations in terms of demographics, mean operative time and risk factors. In 9 (16.9%) patients, the direct hernias were recurrent hernias and all underwent open mesh repair during the index hernia surgery. The majority of hernia repairs (63 hernias in 45 patients, 85%) were performed via the totally extraperitoneal (TEP) approach. 19 patients (35.8%) with 28 direct inguinal hernias underwent primary closure of the direct defect prior to mesh placement; while, 34 patients (64.2%) with 47 direct hernias did not undergo primary closure. There were 3 direct hernia recurrences (6.4%) at 1year post-operatively, and all occurred in the non-closure group. In comparison, there were no recurrences in the closure group; however, this difference was not statistically significant (p = 0.289) in our study due to the small sample size. Closure of direct inguinal hernia defects during laparoscopic mesh repair has been shown to reduce the incidence of early hernia recurrence in our retrospective study but future randomized controlled trials with large numbers would enable us to draw more robust conclusions and perhaps change the way we perform laparoscopic inguinal hernia repair.

A systemically altered connective tissue metabolism has been demonstrated in patients with abdominal wall hernias. The most pronounced connective tissue changes are found in patients with direct or recurrent inguinal hernias as opposed to patients with indirect inguinal hernias. The aim of the present study was to assess whether direct or recurrent inguinal hernias are associated with an elevated rate of ventral hernia surgery. In the nationwide Danish Hernia Database, a cohort of 92,457 patients operated on for inguinal hernias was recorded from January 1998 until June 2010. Eight-hundred forty-three (0.91 %) of these patients underwent a ventral hernia operation between January 2007 and June 2010. A multivariate logistic regression analysis was applied to assess an association between inguinal and ventral hernia repair. Direct (Odds Ratio [OR] = 1.28 [95 % CI, 1.08-1.51]) and recurrent (OR = 1.76, [95 % CI, 1.39-2.23]) inguinal hernias were significantly associated with ventral hernia repair after adjustment for age, gender, and surgical approach (open or laparoscopic). Patients with direct and recurrent inguinal herniation are more prone to ventral hernia repair than patients with indirect inguinal herniation. This is the first study to show that herniogenesis is associated with type of inguinal hernia.

Successful Repair of an Unusual Hernia Associated With Traumatic Pubic Diastasis

Background: Variations of inguinal canal and inguinal nerves are not uncommon. Knowledge about those variations is important to avoid inadvertent injury to the vital structures and to prevent recurrence.Methods: This prospective clinical study included all patients undergoing open inguinal hernia repair. Laparoscopic hernia repair, emergency surgery for complication and recurrent inguinal hernia were excluded. Parameters studied include interspinous distance, length and obliquity of inguinal ligament, attachment of conjoint tendon, condition of transversalis fascia and position and variations of ilioinguinal nerve.Results: The study included 192 patients. The mean interspinous distance (ISD) was 22±3.45 cm (CI: 30-32). ISD was not significant different among the two types of hernia. The mean length of internal oblique on inguinal ligament from anterior superior iliac spine was significantly longer in patients with indirect inguinal hernia (4±0.791 vs. 4.27±1.34; p=0.000). Significant patients in the direct hernia had weak transversalis fascia ((95% vs. 43%). 80% of the patients with direct hernia had defect in the transversalis fascia compared to only 8.8% in the indirect hernia. The difference is statistically significant. The nerve variation was present in only 1.3% in direct hernia group compared to 3.5% in the indirect hernia group.Conclusions: It was observed that the type of hernia did not significantly influenced by the length of inguinal ligament, the mean distance of midinguinal point, obliquity of the inguinal ligament. The nerve variation was present in only 1.3% in direct hernia group compared to 3.5% in the indirect hernia group.

IntroductionThis study was done to analyze the morphometric features of the inguinal canal with different types of inguinal hernias to determine the appropriate size of mesh required to cover potential sites of recurrence. A morphometric assessment in the particular population is essential to recommend the appropriate mesh size in inguinal hernias to cover all the potential sites of recurrence.Materials and methodsThis was a prospective observational study, including all consecutive patients undergoing open inguinal hernia repair under local/regional/general anesthesia over a period of three years. Surgeries that were done in emergencies for complicated hernias, laparoscopic repair, and recurrent inguinal hernias were excluded. Intra-operative parameters were studied to predict the appropriate mesh size, which included the position of the superficial and deep inguinal ring (SIR and DIR) with the diameter, the distance of SIR and DIR from the anterior superior iliac spine (ASIS), and the distance from the summit of the muscular arch to the inguinal ligament. The differences in morphometric details between the types of hernias and categorical variables were assessed using the chi-square test.ResultsThe study included a total of 170 patients with a mean age of 50.67 + 17.59 years. An indirect hernia was the most common type in patients less than 60 years. The mean distance from ASIS to SIR was 10.2+ 1.9 cm, and in indirect hernia patients, it was found to be significantly increased (p=0.042). The mean distance from ASIS to DIR was 4.14+1.57 cm, where the indirect hernia patients had a significantly less distance (p=0.029). The mean length of the inguinal canal in a direct hernia was 5.66 + 0.5 cm, whereas, in an indirect inguinal hernia, it was 6.46 + 0.8 cm, which was significant (p=0.029). The mean distance from the midpoint of the inguinal ligament to the summit of the muscular arch was 4.03 cm, and there was no significant difference between the indirect and direct hernia patients.ConclusionAfter considering the morphometric assessments of the length of the inguinal canal, the mean distance from the midpoint of the inguinal ligament to the summit of the muscular arch, the mean distance from ASIS to DIR, the ideal mesh size for the population would be 9 X 15 cm to cover all the potential sites of recurrence.

INTRODUCTION: Seroma formation in immediate postoperative period is known complication after endoscopic direct inguinal hernia repair. AIM: To study effect of catgut endoloop applied at neck of pseudo sac in preventing occurrence of seroma in laparoscopic direct inguinal hernia repair. MATERIALS & METHOD: 150 patients who underwent endoscopic direct hernia repair were included in this study. They were followed for 1 month for development of seroma. In all the patients' pseudo sac dead space was obliterated by using catgut endoloop. RESULT: In all 150 patients it was possible to prevent clinically visible seroma. CONCLUSION: The primary closure of direct inguinal hernia defects with a pre-lied suture loop during endoscopic repair is safe, efficient, and very reliable for the prevention of post-operative seroma formation, without increasing the risk of developing chronic groin pain or hernia recurrence. This technique should be the preferred method over stapling of the transversalis fascia or the insertion of a closed suction drainage device in such a situation. KEYWORD: Direct inguinal hernia, seroma, catgut endoloop, pseudo sac INTRODUCTION: Post-operative seroma formation after endoscopic management of direct inguinal hernia either by total extra-peritoneal (TEP) or transabdominal pre-peritoneal (TAPP) is a known complication. Because it mimics a postoperative recurrence of hernia, seroma has been a concern to patients. It is suggested that fluid remains trapped between the prosthetic mesh and the transversalis fascia (TF) causing, on a few occasions, a tension seroma that may require repeated follow-up visits and needle aspiration, with a potential risk of iatrogenic infection. Incidence reported in the literature is around 4-5 %. Although techniques such as tacking the pseudo sac to Cooper Ligament or closed suction drain are described, few seem to practice any, probably because the majority of them resolve spontaneously or with repeated aspirations. Therefore, it was proposed to adopt simple measure for seroma prevention by obliterating the pseudo sac with Catgut endoloop and reduce risk of iatrogenic injury and chronic post-operative pain at its minimum. MATERIALS & METHODS: The study was prospective type conducted from Jan 2011 to Dec 2012. 150 patients, who underwent laparoscopic direct inguinal hernia repair, were included. Patients were reviewed in the clinic 2 and 6 weeks after the operation. A single surgeon performed all operations. Each of the M2 or M3 direct defects, according to the European Hernia Society (EHS), was included in this study, while small direct hernias were excluded. After reduction of direct hernia, pseudo sac becomes evident. (FIGURE 1) All meshes were unfolded and under vision cavity were deflated without fixing mesh.

It is generally stated that preoperative differentiation between indirect and direct inguinal hernias by physical examination is inaccurate and irrelevant. With the expansion of the laparoscopic technique, new relevance has emerged. Laparoscopic correction of an indirect hernia is more challenging and time consuming than laparoscopic correction of a direct hernia. Preoperative knowledge concerning the type of hernia informs the laparoscopic surgeon about the required expertise and the expected operative time, and this knowledge is useful for training programs and management. The authors therefore developed a new accurate and easy method of physical examination to differentiate types of inguinal hernia. A prospective study was conducted to determine the accuracy of this new method that combines physical examination with a hand-held Doppler device (not ultrasound) to differentiate types of inguinal hernia. This prospective diagnostics study consisted of two consecutive parts. Each part included 100 consecutive patients presenting with an inguinal hernia. The inguinal occlusion test was used to differentiate the types of inguinal hernia during physical examination in the first part of the study. A hand-held Doppler device was used for adequate localization of the epigastric vessels in addition to the occlusion test in the second part of the study. Preoperative remarks were compared with findings during laparoscopic inguinal hernia repair. The McNemar symmetry χ (2) test was used for statistical evaluation The first part of the study showed a preoperative accuracy of 35 % for direct inguinal hernias and 86 % for indirect inguinal hernias (p < 0.001). The second part of the study showed a preoperative accuracy of 79 % for direct inguinal hernias and 93 % for indirect inguinal hernias (p < 0.001) CONCLUSION: The inguinal occlusion test combined with the use of a handheld Doppler device is accurate in distinguishing direct and indirect inguinal hernias and provides useful management information in laparoscopic inguinal hernia repair.

In 16 years in a provincial paediatric surgical practice, 19 direct inguinal hernias in 14 patients have been encountered amongst over 1,600 inguinal hernia operations. Nearly one-half of these presented as recurrent hernias. Five types of direct hernia were recognized: direct hernia with distinct sac (1 patient); hernia en pantaloon with associated indirect sac (1 patient); sliding direct hernia (1 patient); direct weakness with no indirect sac and no distinct direct sac; and giant indirect hernia with such a huge sac that the whole of the posterior wall of the inguinal canal is encroached upon and weakened. Direct inguinal hernia can be suspected clinically, but positive diagnosis is difficult. It should be suspected at operation if no significant indirect sac is found. Repair of the transversalis fascia seems to be effective surgical treatment, with no known recurrence in this series.

Objective: To determine that inguinal hernia is an inherited disease running in families. Study Design: Prospective Observational. Setting: Surgical Unit I &amp; III of Ghulam Mohammad Mahar Medical College Hospital, Sukkur. Period: June 2017 to May 2022. Methods: A total of 1590 patients of inguinal hernia who presented to surgical OPD or emergency of GMMM College were included in the study. A detailed history was taken and examination done. Important parameters noted were age, gender, occupation, family history of inguinal hernia, degree of relative with inguinal hernia, type of inguinal hernia, primary or recurrent Hernia. Results: Out of total 1590 patients, 1499 (94%) were males and 91 (5.75%) females with male to female ratio of M: F=16.47:1 (Figure-1). Age ranged from 6 to 81 years with mean age of 52.32±15.25 years (Table-I). Out of 1590 patients, 1558 (97%) patients had primary while 32 (3%) had recurrent hernia. Out of 1590 patients, 1081 (68%) patients had direct hernia whereas 509 (32%) had indirect hernia; 843 (53%) were right sided, 722 (45.4%) left sided and 25 (1.6%) were bilateral hernia. Out of 1590 patients, 1312 (82.52%) had positive family history of inguinal hernia whereas 278 (17.48%) had negative family history for inguinal hernia. Out of 1312 with positive family history 971 (74%) patients had first degree relative with hernia, while 341 (26%) had 2nd degree relative with hernia (Table-II). Out of 32 cases of recurrent inguinal hernia, 22 (68.8%) had positive history of 1st degree relative with hernia, 9 (28.1%) had second degree relative with hernia whereas only 1 (3.1%) had negative family history for hernia. Conclusion: Our study concludes that family history of inguinal hernia poses a significant risk for developing hernia.

PurposeWe conducted a multi-institutional analysis to establish the epidemiological characteristics of recurrent inguinal hernia following hernia repair in patients across 4 institutions in Korea.MethodsThe retrospectively reviewed data included patient characteristics, hernia location, year of primary operation, type of hernia, timing of recurrence, primary operation type, and whether a mesh was used.ResultsAmong 4,604 patients who underwent hernia repair surgery, 255 patients (5.5%; 13 females and 242 males; mean age, 63 years) were found to have recurrent hernia from January 2010 to April 2017. Recurrent indirect inguinal and direct hernias were observed in 47.1% and 49.4% of the patients, respectively. The recurrence of hernias within 1 year of surgery was the highest at 17.25%. Early and late recurrences was observed in 23.5% and 66.5% of the patients, respectively. Among the patients, 81.6% underwent open hernia repair at the time of initial surgery.ConclusionRecurrence of hernia is most common in the first year after the initial surgery, and 23.5% of recurrent inguinal hernia was developed within 2 years. Patients underwent surgery after an average of 116 months (median value, 64 months) following the first operation. In patients with recurrent hernia, direct hernia was seen more frequent than indirect hernia whereas indirect hernia occurred more in patients with primary hernia.

Objective To explore the features of multi-slice spiral computed tomography (MSCT) examination of indirect, direct and femoral inguinal hernia. Methods The retrospective cross-sectional study was conducted. The clinical data of 106 patients with indirect, direct and femoral inguinal hernia who were admitted to the First Affiliated Hospital of Xinxiang Medical University between December 2014 and August 2017 were collected. All the patients were diagnosed as inguinal hernia by MSCT examination and multi-planar reconstruction. Observation indicators: (1) sensitivity, specificity, positive and negative predictive values and diagnostic accordance rate of indirect, direct and femoral inguinal hernia by MSCT; (2) inguinal anatomic presentation in MSCT examination; (3) relationship between hernial sac and surrounding structures in MSCT examination; (4) hernia contents and quadrants of hernial sac in the quadrant partition with cross intersect method and complications. Count data were described as absolute number or percentage. Comparison of count data was done using the chi-square test with row multiplied by column. Results (1) Sensitivity, specificity, positive and negative predictive values and diagnostic accordance rate of indirect, direct and femoral inguinal hernia by MSCT: of 106 patients, 66, 22 and 18 were diagnosed as indirect hernia, direct hernia and femoral hernia with 70, 27 and 20 hernial sacs respectively. Sensitivity, specificity, positive and negative predictive values of inguinal hernia by MSCT were respectively 95.7%, 96.3%, 98.5%, 89.7% in indirect hernia patients and 96.3%, 95.7%, 89.7%, 98.5% in direct hernia patients and 100.0%, 100.0%, 100.0%, 100.0% in femoral hernia patients, and diagnostic accordance rate of femoral hernia was also 100.0%. Diagnostic accordance rate of inguinal hernia was 95.9%, and correct index was 0.920. (2) Inguinal anatomic presentation in MSCT examination: transverse, coronal and sagittal imagings of inferior epigastric artery, inguinal ligament, musculus rectus abdominis, femoral vein and other anatomic structures can be identified, and internal ring of inguinal canal of 6 patients cannot be observed clearly. For relationship between internal ring of inguinal canal and inferior epigastric artery, coronal view was the best, transverse view was the next, and sagittal view was rarely observed. For relationship between inguinal ligament and hernial sac, sagittal view was the best, coronal view was also observed clearly by continuous planes, and transverse view was poor. The oblique coronal view was the best for the direct hernial triangle and internal ring of inguinal canal, and coronal view of femoral triangle was the best. The lateral crescent sign and quadrant partition of ross intersect method needed to be observed in transverse plane. (3) Relationship between hernial sac and surrounding structures in MSCT examination: indirect hernia entered into the inguinal canal through internal ring of inguinal canal, and hernial sac was located at the outside of inferior epigastric artery; direct hernia was out through triangle hernia, and hernial sac was located at the inside of inferior epigastric artery, 92.6%(25/27) patients were accompanied by lateral crescent sign. The indirect hernia and direct hernia went along the upper front of inguinal ligament; femoral hernia was out through femoral triangle hernia, and hernial sac was located at the lower back of inguinal ligament and the outside of the pubic tubercle. (4) The hernia contents and quadrants of hernial sac in the quadrant partition with cross intersect method and complications: the most common hernia content was small intestine, including partial patients with hernia content composed of various substances; indirect hernia contents included small intestine (35), mesentery (29), effusion (25), intraabdominal fat (9), colon (8) and ovary (1) in turn; direct hernia contents included small intestine (14), intraabdominal fat (11), effusion (6), mesentery (6), colon (3) and bladder (2) in turn; femoral hernia contents included small intestine (12), intraabdominal fat (8), effusion (3) and mesentery (2) in turn. There was a statistically significant difference in the hernia contents among indirect hernia, direct hernia and femoral hernia (χ2=28.389, P<0.05). The main hernial sac located at antero-external quadrant was respectively occurred in 70 hernial sacs of indirect hernia and 27 hernial sacs of direct hernia and 15 hernial sacs of femoral hernia, and 5 hernial sacs of femoral hernia were located at postero-external quadrant. There was a statistically significant difference in comparison of the quadrant partition with cross intersect method (χ2=78.904, P<0.05). The intestinal obstruction was respectively occurred in 8 patients with indirect hernia and 14 patients with direct hernia and 12 patients with femoral hernia, with a statistically significant difference (χ2=26.674, P<0.05). Conclusions Indirect hernia, direct hernia and femoral hernia have characteristic signs of imaging. MSCT can display precisely the anatomical details of inguinal region, which plays an important role in diagnosis and differential diagnosis of indirect hernia, direct hernia and femoral hernia, especially in display of hernia contents and diagnosis of complications, thus it can provide important information for evaluating risk and making operation plan. Key words: Inguinal hernia; Direct hernia; Indirect hernia; Femoral hernia; Multi-slice spiral computed tomography; Multiple planar reconstruction

Inguinal hernia is frequently diagnosed by clinical exam. Imaging tests are recommended in the absence of definitive signs or associated symptoms that indicate complications. Ultrasonography (US) is the most common method used for examination of the various types of hernias. Inguinal hernias are the most prevalent type of hernia. US (grayscale or color Doppler ultrasonography) are suggested for examining inguinal hernias. CT is used to differentiate inguinal and femoral hernia based on the correlation between the hernia sac and pubic tubercle. Magnetic resonance imaging (MRI) is favored for diagnosing occult inguinal hernias when there are constraints associated with US and computed tomography (CT); or a lack of definitive diagnostic results Inguinal hernia is an acquired or congenital condition wherein the abdominal cavity contents protrude into the inguinal canal. In men, the testes migrate from the abdomen into the scrotum through the inguinal canal. Thus, men (more than women) are more likely to develop an indirect inguinal hernia. An indirect hernia can occur congenitally. Indirect inguinal hernias present on the lateral side of the Hesselbach triangle and enter the inguinal canal through the deep or internal inguinal ring. Direct inguinal hernias constitute inguinal hernias that protrude through the Hesselbach triangle, remaining medial and caudal to the inguinal canal’s origin at the internal inguinal ring. These hernias are common in older males and carry a lower risk of strangulation. The characteristic sign of a direct hernia on CT is a lateral fat crescent.