Concept: Which Operation for Inguinal Hernia?

  • Jameson L. Chassin


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.


Inguinal Hernia Internal Ring Inguinal Ligament Transversus Abdominis Transversalis Fascia 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Berliner S, Burson L, Katz P, Wise L. An anterior transversalis fascia repair for adult inguinal hernias. Am J Surg 1978;135:633.PubMedCrossRefGoogle Scholar
  2. Halverson K, McVay CB. Inguinal and femoral hernioplasty: a 22-year study of the author’s methods. Arch Surg 1970;101:127.PubMedCrossRefGoogle Scholar
  3. Lichtenstein IL. Hernia repair without disability. St. Louis: Mosby; 1970.Google Scholar
  4. Nyhus LM, Condon RE (eds) . Hernia, 2nd edn. Philadelphia: Lippincott; 1978.Google Scholar
  5. Rutledge RH. Cooper’s ligament repair for adult groin hernias. Surgery 1980;87:601.PubMedGoogle Scholar
  6. Ryan EA. An analysis of 313 consecutive cases of indirect sliding hernias. Surg Gynecol Obstet 1956;102:45.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 1994

Authors and Affiliations

  • Jameson L. Chassin
    • 1
    • 2
  1. 1.Clinical SurgeryNew York University School of MedicineNew YorkUSA
  2. 2.Department of SurgeryNew York Hospital Medical Center of QueensFlushingUSA

Personalised recommendations