News Feed Discussions How to tell the difference between direct and indirect inguinal hernia?

  • How to tell the difference between direct and indirect inguinal hernia?

    Posted by John Fortem on August 12, 2018 at 5:49 pm

    As a layman, is it possible to differentiate direct from indirect inguinal hernia without seeing a surgeon?

    Is direct vs. indirect hernia comparable to medial vs. lateral hernia?

    I have seen the images and videos explaining this online, but it is still difficult for me to know which one I have.

    For instance, is it more common for direct hernia to go down to the scrotum? I think I read a paragraph somewhere that explained it along those lines. If true, that might serve as an indicator.

    John Fortem replied 5 years, 8 months ago 3 Members · 4 Replies
  • 4 Replies
  • John Fortem

    Member
    September 23, 2018 at 10:11 pm

    Thank you!

    Since I have had it at the same place all this time I suspect I have a direct inguinal hernia. I don’t think it’s very likely that it’s a femoral hernia, even though it is close to those structures. I think it protrudes just above the inguinal ligament close to the mid-line. So I think it’s most likely a direct hernia.

    Just like Jeremy here, I am still researching my options. I am also leaning towards a non-mesh repair, most likely using the Desarda technique, or a modified Shouldice technique without a steel wire. Since my healthcare provider is only offering mesh, I will be using my savings to pay for it. It’s very important that I find a surgeon who I can put my trust in.

  • Jeremy B

    Member
    August 13, 2018 at 7:13 pm

    As I understand it; Direct hernia occurs medial to the vessels, which is closer to the centerline of the body and very rarely comes into the scrotum and rarely is dangerous.
    Indirect glides through where the spermatic cord is and can go to the ballsack and has a greater chance of incarceration.
    I found out I have a Direct hernia through ultrasound, It’s not commonly ordered amongst the masses. I’m living with it until I can find a surgeon I am comfortable with doing a quality mesh free repair. I am in MN and have had no luck finding anyone around here; Mesh Mesh Mesh all the way…
    -Jeremy

  • Chaunce1234

    Member
    August 12, 2018 at 11:54 pm

    I posted a reply but it was flagged as spam for some reason.

    Anyway, not a doctor, but I think the indirect is more likely to enter the scrotum because it follows where your testicles descended originally, while the direct is less likely. And the third groin hernia variety, the femoral hernia follows the femoral vein to the leg/groin crease.

  • John Fortem

    Member
    August 12, 2018 at 5:51 pm

    Not that seeing a surgeon always helps… I mean I saw one and he just looked at it and confirmed it was a hernia. Well, since there is a bulge in my groin, any layman will tell you what you have. He was not specific about what kind of hernia it was. It is a groin or inguinal hernia alright, even I know that. But is it direct or indirect? He said I should have it repaired if it is bothersome, and that I will have to do it eventually.

    I said no to surgery back then.

    A) I resent the idea of using a permanent mesh to cover the defect, and that’s the only way he would do it, because that’s how it’s done today. I had no other option. Other than to say no and live with it. I have lived and survived to tell you the story. I have had it for 8 years now and I have not had any major problem with it, least of all strangulation which is sometimes used as a form of scare tactic.

    B) I don’t have respect nor confidence in a surgeon who doesn’t want or know how to set a proper diagnosis by palpation, or by ordering ultrasound, CT or MRI scans.

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