الفهرس يوجد فقط 14 صفحة متاحة للعرض العام
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المستخلص
Hernia is defined as abnormal protrusion of a peritoneal-lined sac through the muscloaponeurotic covering of the abdomen. ( )
Hernia repair is currently the most commonly performed general surgical operation; it occurs with a greater frequency in men than women (12:1 ratio) and accounts for nearly 800,000 cases per year in the United States. ( ) Inguinal hernias are still the most common form of hernia in either male or female patients.
An understanding of the anatomy of the anteroinferior abdominal wall is vital to an understanding of inguinal hernia and its repair.
Inguinal anatomy:
“No disease of the human body, belonging to the province of the surgeon, requires in its treatment, a better combination of accurate, anatomical knowledge with surgical skill than hernia in all its varieties”.
Sir Astley Paston Cooper, 1804. ( ) (Figure 1)
The discussion of hernia anatomy typically begins with the myopectineal orifice of Fruchaud. ( )
The myopectineal orifice of Fruchaud (Figure 2):
In 1956, Henry Fruchaud espoused the theory that all groin (inguinofemoral) hernia originate in a single weak area called the myopectineal orifice. The abdominal wall in this region is supported only by the transversalis fascia and the tendinous insertion of the transversalis muscle. These 2 thin layers of tissue are bordered superiorly by the arch of the internal oblique and transversus abdominis muscles. Medially, the rectus abdominis and the rectus sheath provide support. Inferiorly, Cooper’s ligament, and laterally, the iliopsoas muscle, borders this egg-shaped region. The inguinal ligament divides the orifice into superior and inferior halves. Superiolaterally, the internal ring allows the passage of spermatic cord structure in men and the round ligament on its path to the labia in women.
More medially, there is a potential space if laxity of the floor of the inguinal canal allows herniation of abdominal contents medial to the epigastric vessels. This triangular area of weakness has been described by Hesselbach ( ) and Hessert ( ) and is also known as the medial triangle or the direct space. Inferiorly, the femoral artery and vein, femoral nerve, and lymphatics pass from the abdomen to the leg and vice versa through the femoral canal. Again, this space is prone to failure and development of a femoral hernia. Hernias can be classified as indirect, direct, or femoral as they course through the 3 spaces described above, respectively.
Femoral hernias, initially felt to be distinct from inguinal hernias, are now grouped with them as a variation of groin hernia. The classification of this hernia as being different from the standard inguinal hernia was arbitrary. Although the hernia does not emerge through the inguinal canal, it does perforate the myopectineal orifice and travel deep to the inguinal canal to exit into the superiomedial thigh.