Concept: Which Operation for Inguinal Hernia
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. The attenuated portion of the transversalis fascia is of no use in the repair. Along the superior and medial margins of the weak area, one may use the uninjured portion of the transversalis fascia together with the aponeurosis of the transversus abdominis muscle. On the inferolateral aspect of the weak area, a rim of transversalis fascia, called the iliopubic tract by Nyhus and Condon, is generally intact and useful in the repair. If this is not the case, either the shelving edge of the inguinal ligament or Cooper’s ligament is available.
KeywordsInguinal Hernia Femoral Hernia Inguinal Ligament Transversalis Fascia Indirect Inguinal Hernia
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