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.