Theories for Hernia formation
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1. Russell's theory - pre-formed sac.
2. Reid's
metastatic emphysema theory - d.t. smoking.
3. Cloquet's
lipoma theory - pile driver action of fat.
4. Fruchaud's
theory - big opening in the lower abdomen - between the pubic bone and conjoint
tendon. Divided into two by inguinal ligament. Through the upper part passes
the inguinal hernia, while through the lower part passes the femoral hernia.
5. Denervation
theory - Ilioinguinal N. esp after appendectomy.
6. Oblique pelvis - high
arch of the internal oblique - inefficient shutter mechanism - prone to
inguinal hernia.
7. Wide female pelvis - Lower arch
of internal oblique - more efficient shutter mechanism - indirect inguinal
hernias are uncommon in females. Results in wider femoral ring - femoral
hernias commonest in females.
8. Uglavasky
theory - Chronic increased IAP
9. Peacock's
theory - defective collagen synthesis.
10. Walk's theory - weakness of
abdominal wall at exit of neurovascular bundle.
11. Keith's theory - stress related
degeneration of connective tissue - especially in the fascia transversalis.
12. Deficient insertion of the
conjoint tendon seen in males - especially white males - pre-disposes to direct
inguinal hernia - less support to posterior inguinal canal wall. Attachment
quite wide in females - direct hernia almost never occurs in females.
13. Dr. Desarda's theory: Adynamic and weak posterior wall due to absent or deficient aponeurotic extensions is the main cause of hernia formation. Loss of shielding action of the muscles and binding action of the interparietal connective tissue are also important factors.
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(Live operation on
direct, indirect & recurrent groin hernia)
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