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   Anatomy of the inguinal canal Hide   

    The inguinal canal is an oblique canal which runs from the deep ring (mid point of inguinal ligament) to the superficial ring in the inguinal region.

    The inguinal canal contains:
        - The spermatic chord in men
        - The round ligament in women

    The boundaries:

    Superior (Roof): From lateral to medial is comprised of Transversus abdominus aponeurosis, internal oblique aponeurosis and conjoint tendon.
    Inferior (Floor): Inguinal ligament and lacunar ligament
    Anterior: External oblique aponeurosis (strengthened laterally by internal oblique fibres)
    Posterior: Transversalis fascia (strengthened medially by the conjoint tendon)

    The borders of the deep ring:
        - Medially - Transversalis fascia and inferior epigastric vessels
        - Laterally - Transversus abdominus and internal oblique aponeurosis

    The border of the superficial ring:
        - Medially - Conjoint tendon
        - Laterally - External oblique

    The table below summarises the anatomy of the inguinal canal:

Author: Mr Kasun Wanigasooriya MBCHB, MRCS  | Speciality: Anatomy  | Date Added: 06/02/2011

  Linked tutorial: Surgical Procedure - Open inguinal hernia repair (Tension free mesh repair) Expand   

    Short notes on open inguinal hernia repair:

    Step 1 - Transverse skin incision 1cm above inguinal ligament

    Step 2 - Dissect down and through Scarpas with diathermy; use self retainer
                (remember the superficial branch of inferior epigastric vein)
    Step 3 - Clips on external oblique, and incise a small opening in direction of fibres

    Step 4 - Scissors under external oblique and open to superficial ring

    Step 5 - Develop planes parallel to cord with blunt dissection

    Step 6 - Get around cord at level of pubic tubercle

    Step 7 - Develop planes and identify cord structures

    Step 8 - Peel hernia sac off cord structures towards deep ring, until at the level of pre-peritoneal fat

    Step 9 - Transfix base of sac with 2-0 vicryl leaving long suture tails for control, and transect, check for haemostasis and then cut stitch

    Step 10 - Repair direct defect by plicating transversalis if necessary

    Step 11 - Cut mesh and suture on to strong tissue adjacent to pubic tubercle with 2-0 prolene (other options include: Progrip mesh, PHS (Prolene Hernia System) mesh etc)

    Step 12 - Use a continuous stitch from inferior border of mesh to inferior border of inguinal ligament

    Step 13 - Tack medial side of mesh to transversalis (2-3 interrupted sutures)

    Step 14 - Tack inferior border of upper leg of mesh to lower border of lower leg of mesh incorporating part of the inguinal ligament

    Step 15 - Close eternal oblique from lateral to medial with 2-0 vicryl maintaining a superficial ring

    Step 16 - Close Scarpas with 2-0 vicryl

    Step 17 - Close skin with 3-0 monocryl

    Step 18 - Check testicle is in scrotum and pull down if necessary

    Disclaimer: These notes are to act as an aide memoire. Different methods exist. Ensure you have the proper supervision before attempting an operation that you are not competent in.

Author: Mr Edward Rawstorne MBBCH, BSc, MRCS | Speciality: Surgical Procedures | Date Added: 30/03/2013


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