Concept: Which Operation for Inguinal Hernia?

Abstract

Indirect inguinal hernia, even in adult life, is probably caused by the persistence of a patent processus vaginalis and can therefore be classified as a congenital lesion. A patient with this type of hernia is not born with a muscular or aponeurotic weakness; instead, as the neck of the indirect hernia enlarges over a period of years, pressure may produce weakness of the adjacent transversalis fascia. In the geographical area in which we practice, the ready availability of good pediatric care and pediatric surgeons has resulted in the detection and repair of many indirect inguinal hernias during infancy and childhood. Consequently, the majority of our adult hernias are direct in nature, their most probable cause being wear and tear. In the region of Hasselbach’s triangle the only structures between the peritoneum and the skin are the transversalis fascia and the external oblique aponeurosis. Once the transversalis fascia becomes attenuated and stretched, a direct hernia will bulge through the external inguinal ring.