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