Surgical anatomy inguinal canal dr mnr

SURGEON AND THE INGUINAL CANAL

1. SURGICAL ANATOMY OF
INGUINAL HERNIA
DR MUHAMMED MUNEER M
MS GENERAL SURGERY
SGMC & RF
TRIVANDRUM KERALA

2. Abdominal wall divided In to-
Anterolateral abdominal wall
1.Anterior wall
2.Rt lateral wall
3.Lt lateral wall
Posterior abdominal wall

3. .
Anterior wall extent frm thorasic cage to pelvis
& bounded by superiorly d cartillage of 7
th
thru
10
th
rib &xiphoid process
Inferiorly,inguinal ligament & pelvic bone.
Wall-
skin,s/c tissue(fat),muscle,fascia,parietal
peritonium

4. .

5. .
Skin
Superficial fatty layer-CAMPER’S
Membranous deep layer-SCARPA’S
Muscles-5 muscle} - 3 flat muscle-EO
-IO
-TA
-2 vertical muscle-
(rectus abdominis n pyramidalis)

6. .

7. .
All 3 flat muscle end anteriorly in strong
sheet like aponeurosis

8. INGUINAL CANAL
Intermuscular slit situated b/w superficial &
deep ring.
Oblique passage (adult), 3.75cm long ,
medial ½ of inguinal ligament.
Superficial ring; triangular opening in
external oblique aponeurosis 1.25 cm abv &
lateral to pubic tubercle, bounded by
superomedial n inferolateralcrus (stronger).

9. .

10. .

11. Deep ring-
Verticaly oval shaped ,formed by condensation of
transversalis fascia , 1.25 cm abv mid inguinal
point.
Inguinal ligament-(poupart’s ligament)
Formed by lower border Of EO aponeurosis which
is thickned & folded back on itsself ,extend ASIS to
pubic tubercle

13. Content
Spermatic cord in male
Round ligament in female
Illioinguinal nerve (pierces IO n come)
Remnant process vaginalis +/-

14. .

15. Boundaries
ANTERIOR- Skin, superficial fascia, external
oblique aponeurosis & internal oblique muscle
lateraly.
POSTERIOR- inferior epigastric Artery,
fasciatransversalis & conjoint tendon medialy
(combination of IO n Transversus muscle) &
relected part of inguinal ligament.
ABOVE - arched fibers of conjoint muscle ( IO
muscle + transversus muscle )
BELOW- inguinal ligament

16. Defence mechanism of inguinal canal
Obliquity of i.c ( abdmn pres; rise,oclude)
Arching of conjoint tendon-posterior wall
strengthen
Shutter mech; of internal oblique
Ball valve mech:of cremastric muscle which
plug d superior ring
Slit valve mechanism; EO contract intercrural
fiber of superficial ring appose.

17. .
.
.

18. Spermatic cord content
3 fascia 3 artery 3 vein 2 nerve
Fascia- external spermatic fascia
cremastric fascia
internal spermatic fascia
Artery- testicular artery
cremastric artery,deferential A
Vein- pampiniform plexus & testicular vein
Cremastric vein,deferential vein.
Nerve- genital br of genito femoral (L 2)
symptic plexus

19. RELATED NERVE ,ARTERY, VEIN
NERVE SUPPLY- muscle & skin segmental sply from
T 7---L 1
Thoraco abdominal nerves (inferior inter costel nerve) T7—T11
Subcostal nerve T12
umbilicus—T 10
Groin & scrotum– L1
illi hypo gastric nerve.T12-L1
Illio inguinal –L1
Genitofemoral—L1L2L3

20. .

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22. .

23. Artery
Superior epigastric A -(internal thorasic A)
Inferior epigastric A -( external iliac A)
Deep circumflex iliac A - (external iliac A)
Superficial circumflex iliac A -(external iliac A)
Superficial epigastric A – (femoral A

24. .

25. .

26. Artery of death..
Abnormal obturator artery—
Obturator & inferior epigastric A usually gives a pubic
branch which is small & anastomos @ back of pubis
30% case, pubic branch of IEA is very large,taking d
place of obturator A & being known as abnormal
obturator A
It go down in relation to femoral ring to reach
obt.foramen
In 10% case person with such A pass down along
edge of lacunar ligament
Femoral hernia repair..some time need dividing of
this ligament cause bleeding…

27. .

28. Hesselbach’ triangle-inguinal triangle

31. Mayopectenial foramen of FRUCHAUD

32. .
Above- myoaponeurotic arch of lower edge of
IO & TA
Below –pectenial line of supra pubic ramus
Lateral-iliopsoas muscle
Medial-lateral border of rectus
Upper ½ & lower ½
Closed posteriorly by transeversalis fascia

33. Space of bogros
Located in front of peritonium beneath d
posterior lamina of transversalis fascia, it is d
lateral extension of d retropubic sps of
Retzius.

34. Triangle of DOOM

36. .
Misnomer.. Inverted V shaped area ,apex
deep ring,medial border vas deference,
lateraly by gonadal vessel,inferiorly by
external illiac vessels.
 only 2 borders
Avoid staplers n suturs here.

37. TRIANGLE O PAIN

38. Anterior- iliopubic tract/inguinal ligament
Posteromedial-gonadal vessel.

39. .

40. HERNIA
Protrution of a viscus in part or in whole
through a normal or abnl opening in
relation to the abdmen.

41. Components of a hernia

42. HERNIA-CLASSIFICATION
ANATOMICAL- indirect & direct
CLINICAL- reducible,irreducible,obstructed&
incarcinated,strangulated,inflamed
ACCORDING TO EXTEND-incomplete
-bubonocele(sac contined t0 IC),funicular(Sac cross
super. Ring,not reach bottom o scrotum)
- complete- sac each bottom o scrotum
CONGENITAL & ACQUIRED
CONDENT:
Omentocele-omentun

43. .
Enterocele-bowel
Cystocele-bladder
Littre’s hernia-meckel’s diverticulam
Maydl’s hernia- 2 loop of bowel remain
in sac connecting loop in abdmn n
became strangulate.
Richter’s herinia-part of bowel

44. maydls hernia

45. Richters hernia

46. Sliding hernia
A piece of extraperitoneal bowel may
slide down into i.c pulling a sac of
peritoneum with it.
Posterior wall is not form by peritoneum
alone,but by viscus which lies behind d
peritoneum

47. .

48. Based on site
Inguinal hernia-inguinal canal
Femoral hernia-femoral canal
Obturator hernia
Diaphragmatic hernia
Lumbar hernia
Spigelian
Umbilical
Epigastic hernia
Gluteal hernia
Incisional hernia

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59. Skin fix to lnea alba

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66. Thank you