What defines a direct hernia?

A direct hernia is characterized by a protrusion of abdominal contents through a weakness in the abdominal wall, specifically through the inguinal canal's fascia. The key defining feature of a direct hernia is the weakness of the fascial margin of the internal ring, which allows for this herniation to occur. In men, this typically occurs in an area called Hesselbach's triangle, where there is an inherent weakness in the abdominal wall musculature.

This contrasts with indirect hernias, which occur due to a defect at the internal inguinal ring and are often congenital. Understanding the specific anatomical and physiological basis of a direct hernia helps to appreciate surgical approaches and strategies for repair. By recognizing that the primary factor is the weakness of the fascial margin, one can understand why addressing this weakness is critical in surgical techniques used to repair the hernia effectively.