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Abstract
Four points in the anatomy of the inguinal region are brought out; first, the close
relationship between the internal ring and the free edge of the transversus abdominis
above and with Poupart's ligament below; second, the fact that the transversus abdominis
is aponeurotic at this point; third, that the transversus abdominis aponeurosis and
the transversalis fascia are almost on planes of identical depth in the makeup of
the abdominal wall; fourth, the dangerous position of the deep epigastric vessels
medial to the inner margin of the internal abdominal ring.
Considering these anatomical facts, a technic has been devised in which the aponeurosis
of the transversus abdominis is sewed down to the shelving margin of Poupart's ligament,
the ring margins being included in the sutures for the closure of the dilated internal
ring found in association with indirect inguinal hernias. The intimate reinforcement
given by this technic, and the lack of “dead space” following its use is emphasized.
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References
- Surg., Gynec. & Obst. 1938; 66: 186
- Anat. Rec. 1938; 70: 211
- Quart. Bull. North. U. Med. School. 1942; 16: 20
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© 1946 Published by Elsevier Inc.
