Applied anatomy of inguinal hernias.pptx

inguinal hernias and their anatomy

1. Applied anatomy of inguinal hernia Aniket Dave Moderator: Dr. Vineet Mannan

2. References Gray’s Anatomy – 40 th edition Atlas of human anatomy (Frank H. Netter) – 5 th edition Clinically oriented anatomy (Keith L. Moore) – 7 th edition Sabiston Textbook of surgery – 19 th edition Nyhus and condon’s HERNIA – 5 th edition Laparoscopic hernia repair (RK Mishra)

3. Anterior abdominal wall

4. Inguinal canal Natural hiatus in the tissues of anterior abdominal wall Connects the abdominal cavity to the scrotal sac 4cm long, directed inferomedially Bound by 2 rings at either ends

5. Embryology of inguinal canal Keith L Moore 205 Fig 2.16

6. Embryology of inguinal canal

7. Embryology of inguinal canal

8. Deep inguinal ring 1.25cm above the inguinal ligament at the mid inguinal point Evagination in the transversalis fascia Vertically oval shape Lateral to inferior epigastric vessels Fibres from transversalis fascia continue as internal spermatic fascia

9. Superficial inguinal ring Just above and lateral to the pubic crest Hiatus in the external oblique aponeurosis Triangular in shape Fibres from ext oblique aponeurosis continue downwards as the external spermatic fascia

10. Inguinal canal Keith L Moore Page 204 Fig 2.15 A

11. Boundaries of inguinal canal Keith L Moore 204 Table 2.5

12. Contents Males Females Spermatic Cord : 3 arteries: artery to vas, testicular artery, cremasteric artery 3 fascial layers: external spermatic, cremasteric , internal spermatic fascia 3 other structures: pampiniform plexus, vas deferens, testicular lymphatics 3 (2+1) nerves: genital branch of the genitofemoral nerve, sympathetic and visceral afferent fibres, ilioinguinal nerve Round ligament Ilioinguinal nerve Ilioinguinal nerve

13. Inguinal ligament Thick, inrolled lower border of Ext oblique aponeurosis From ASIS to pubic tubercle Lateral half- rounded and more oblique Medial half- wider and more horizontal (supports spermatic cord) At the medial end, some fibres extend in 2 separate directions: Lacunar ligament (posteriorly and laterally) Reflected part (upwards and medially)

14. Netters Plate 253 1 st image

15. Lacunar ligament Triangular band of tissue posterior to medial end of inguinal ligament Apex attached to pubic tubercle Curved base forms medial border of femoral canal Continues posterolaterally on to pectineal line as Cooper’s ligament

16. Iliopubic tract Thickened inferior margin of transversalis fascia Fibrous band running parallel and deep to inguinal ligament Seen in place of inguinal ligament when viewed from the internal (posterior) aspect Reinforces the posterior wall

17. Conjoint tendon Inguinal falx Lower fibres of internal oblique and tranversus abdominis Arches over the inguinal canal and descends posterior to the superficial ring Attached to pubic crest and pectineal line Strengthens medial part of posterior wall

18. Inferior epigastric artery Originates from Ext iliac artery 2 veins accompany In the region of the inguinal canal it is between the transversalis fascia and peritoneum Later pierces transversalis fascia and ascends between rectus abdominis muscle and the fascia

19. Hasselbach’s triangle

20. Corona mortis

21. Preperitoneal space

22. Anatomy of inguinal hernia

23. Laparoscopic anatomy of inguinal hernia Netters 247

24. TEP hernia repair

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