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EHS European Hernia Society groin hernia classification
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EHS groin hernia classification table lateral medial femoral recurrent
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Here is the complete EHS (European Hernia Society) classification:
EHS Classification of Hernias
The EHS proposed a simple, intraoperative classification system based on the Aachen classification. It covers both groin hernias and incisional hernias.
1. EHS Groin Hernia Classification
The system uses three variables: location, defect size, and primary vs. recurrent status.
Location (anatomical)
| Code | Type |
|---|---|
| L | Lateral (Indirect inguinal) |
| M | Medial (Direct inguinal) |
| F | Femoral |
Defect Size (measured by finger breadths intraoperatively)
| Code | Size |
|---|---|
| 0 | No palpable defect (laparoscopic finding only) |
| 1 | ≤1 finger breadth (~<1.5 cm) |
| 2 | 1-2 finger breadths (~1.5-3 cm) |
| 3 | ≥3 finger breadths (~>3 cm) |
| x | Not examined / unknown |
Status
| Code | Meaning |
|---|---|
| P | Primary hernia |
| R | Recurrent hernia |
How to Use It
You tick the appropriate box on a grid:
| Primary (P) | Recurrent (R) | |
|---|---|---|
| 0 / 1 / 2 / 3 / x | 0 / 1 / 2 / 3 / x | |
| Lateral (L) | ||
| Medial (M) | ||
| Femoral (F) |
Example: A primary large indirect inguinal hernia = L3-P. A recurrent femoral hernia of unknown size = F-x-R.
For combined hernias (e.g., pantaloon = indirect + direct), both boxes are ticked separately.
This is based on the Miserez et al. 2007 EHS consensus paper (PMID 17353992), and also cited in Mulholland & Greenfield's Surgery, 7e, Table 72.3.
2. EHS Classification of Incisional Hernia
(Muysoms et al., 2009)
Location
| Code | Position | Subtype |
|---|---|---|
| M1 | Midline - Subxiphoid | |
| M2 | Midline - Epigastric | |
| M3 | Midline - Umbilical | |
| M4 | Midline - Infraumbilical | |
| M5 | Midline - Suprapubic | |
| L1 | Lateral - Subcostal | |
| L2 | Lateral - Flank | |
| L3 | Lateral - Iliac | |
| L4 | Lateral - Lumbar |
Width of Defect
| Code | Width |
|---|---|
| W1 | <4 cm |
| W2 | 4-10 cm |
| W3 | >10 cm |
Other Parameters Recorded
- Recurrent incisional hernia: Yes / No
- Length (cm) of defect
- Width (cm) of defect (for exact measurement, in addition to W1/W2/W3 category)
Source: Mulholland & Greenfield's Surgery, 7e, Table 72.10
Clinical Relevance
- The EHS groin classification is recommended in international guidelines (HerniaSurge) for tailored treatment, research, and audit.
- Mesh fixation is specifically recommended for M3-EHS (large direct hernia) in laparoscopic TAPP/TEP repair to reduce recurrence.
- The system is intentionally simple to encourage uniform reporting in operative notes and research papers, enabling better meta-analysis comparability.
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"incisional hernia"[MeSH Terms] AND "surgical mesh"[MeSH Terms]
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"incisional hernia"[MeSH Terms] AND "herniorrhaphy"[MeSH Terms]
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