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Surgical physiology of inguinal hernia repair--a study of 200 cases.

Desarda MP - BMC Surg (2003)

Bottom Line: The movement of the muscle arch improved after it was sutured to the upper border of a strip of the external oblique aponeurosis (EOA).The newly formed posterior wall was kept physiologically dynamic by the additional muscle strength provided by external oblique muscle to the weakened muscles of the muscle arch.In addition, the squeezing and plugging action of the cremasteric muscle and binding effect of the strong cremasteric fascia, also play an important role in the prevention of hernia.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Surgery, Poona Hospital & Research Centre, Pune-411030, India. desarda@vsnl.net

ABSTRACT

Background: Current inguinal hernia operations are generally based on anatomical considerations. Failures of such operations are due to lack of consideration of physiological aspects. Many patients with inguinal hernia are cured as a result of current techniques of operation, though factors that are said to prevent hernia formation are not restored. Therefore, the surgical physiology of inguinal canal needs to be reconsidered.

Methods: A retrospective study is describer of 200 patients operated on for inguinal hernia under local anaesthesia by the author's technique of inguinal hernia repair.

Results: The posterior wall of the inguinal canal was weak and without dynamic movement in all patients. Strong aponeurotic extensions were absent in the posterior wall. The muscle arch movement was lost or diminished in all patients. The movement of the muscle arch improved after it was sutured to the upper border of a strip of the external oblique aponeurosis (EOA). The newly formed posterior wall was kept physiologically dynamic by the additional muscle strength provided by external oblique muscle to the weakened muscles of the muscle arch.

Conclusions: A physiologically dynamic and strong posterior inguinal wall, and the shielding and compression action of the muscles and aponeuroses around the inguinal canal are important factors that prevent hernia formation or hernia recurrence after repair. In addition, the squeezing and plugging action of the cremasteric muscle and binding effect of the strong cremasteric fascia, also play an important role in the prevention of hernia.

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Section of inguinal canal at rest. 1) External oblique aponeurosis, 2) Internal oblique muscle, 3) Transversus abdominis muscle, 4) Endo abdominal fascia, 5) Internal inguinal ring, 6) Iliopubic tract, 7) Inguinal ligament, 8) Pubic symphisis, 9) Spermatic cord, 10) Interparietal connective tissue (cremasteric fascia), 11) cremasteric muscle, 12) Aponeurotic layer of posterior inguinal wall, 13) Fascial layer of posterior inguinal wall
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Figure 3: Section of inguinal canal at rest. 1) External oblique aponeurosis, 2) Internal oblique muscle, 3) Transversus abdominis muscle, 4) Endo abdominal fascia, 5) Internal inguinal ring, 6) Iliopubic tract, 7) Inguinal ligament, 8) Pubic symphisis, 9) Spermatic cord, 10) Interparietal connective tissue (cremasteric fascia), 11) cremasteric muscle, 12) Aponeurotic layer of posterior inguinal wall, 13) Fascial layer of posterior inguinal wall

Mentions: There are constant internal blows on the abdominal wall from inside during every act of coughing, sneezing, straining etc. All the abdominal muscles contract to form a shield against the force of such internal abdominal blows. Phulchound's musculopectineus opening in the abdominal wall near the groin is a weak area because it does not have the cover of all abdominal muscles. Forceful contraction of the strong diaphragmatic muscle, in every act of coughing, straining etc. increases the burden on this weak area, over and above the effect of gravitational force. Inspite of this, not every individual suffers from inguinal hernia because of the protective mechanism, which operates to prevent the inguinal herniation in the normal individuals. Following protective mechanism works in such situations. (Figure 3, Figure 4, and Figure 5)


Surgical physiology of inguinal hernia repair--a study of 200 cases.

Desarda MP - BMC Surg (2003)

Section of inguinal canal at rest. 1) External oblique aponeurosis, 2) Internal oblique muscle, 3) Transversus abdominis muscle, 4) Endo abdominal fascia, 5) Internal inguinal ring, 6) Iliopubic tract, 7) Inguinal ligament, 8) Pubic symphisis, 9) Spermatic cord, 10) Interparietal connective tissue (cremasteric fascia), 11) cremasteric muscle, 12) Aponeurotic layer of posterior inguinal wall, 13) Fascial layer of posterior inguinal wall
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC155644&req=5

Figure 3: Section of inguinal canal at rest. 1) External oblique aponeurosis, 2) Internal oblique muscle, 3) Transversus abdominis muscle, 4) Endo abdominal fascia, 5) Internal inguinal ring, 6) Iliopubic tract, 7) Inguinal ligament, 8) Pubic symphisis, 9) Spermatic cord, 10) Interparietal connective tissue (cremasteric fascia), 11) cremasteric muscle, 12) Aponeurotic layer of posterior inguinal wall, 13) Fascial layer of posterior inguinal wall
Mentions: There are constant internal blows on the abdominal wall from inside during every act of coughing, sneezing, straining etc. All the abdominal muscles contract to form a shield against the force of such internal abdominal blows. Phulchound's musculopectineus opening in the abdominal wall near the groin is a weak area because it does not have the cover of all abdominal muscles. Forceful contraction of the strong diaphragmatic muscle, in every act of coughing, straining etc. increases the burden on this weak area, over and above the effect of gravitational force. Inspite of this, not every individual suffers from inguinal hernia because of the protective mechanism, which operates to prevent the inguinal herniation in the normal individuals. Following protective mechanism works in such situations. (Figure 3, Figure 4, and Figure 5)

Bottom Line: The movement of the muscle arch improved after it was sutured to the upper border of a strip of the external oblique aponeurosis (EOA).The newly formed posterior wall was kept physiologically dynamic by the additional muscle strength provided by external oblique muscle to the weakened muscles of the muscle arch.In addition, the squeezing and plugging action of the cremasteric muscle and binding effect of the strong cremasteric fascia, also play an important role in the prevention of hernia.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Surgery, Poona Hospital & Research Centre, Pune-411030, India. desarda@vsnl.net

ABSTRACT

Background: Current inguinal hernia operations are generally based on anatomical considerations. Failures of such operations are due to lack of consideration of physiological aspects. Many patients with inguinal hernia are cured as a result of current techniques of operation, though factors that are said to prevent hernia formation are not restored. Therefore, the surgical physiology of inguinal canal needs to be reconsidered.

Methods: A retrospective study is describer of 200 patients operated on for inguinal hernia under local anaesthesia by the author's technique of inguinal hernia repair.

Results: The posterior wall of the inguinal canal was weak and without dynamic movement in all patients. Strong aponeurotic extensions were absent in the posterior wall. The muscle arch movement was lost or diminished in all patients. The movement of the muscle arch improved after it was sutured to the upper border of a strip of the external oblique aponeurosis (EOA). The newly formed posterior wall was kept physiologically dynamic by the additional muscle strength provided by external oblique muscle to the weakened muscles of the muscle arch.

Conclusions: A physiologically dynamic and strong posterior inguinal wall, and the shielding and compression action of the muscles and aponeuroses around the inguinal canal are important factors that prevent hernia formation or hernia recurrence after repair. In addition, the squeezing and plugging action of the cremasteric muscle and binding effect of the strong cremasteric fascia, also play an important role in the prevention of hernia.

Show MeSH
Related in: MedlinePlus