Inguinal hernia repairphysiologyinguinal canalprotective mechanism

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. Background Inguinal hernia repair still remains a problem because of the 1) high recurrence rates seen in the hands of the junior surgeons, 2) risky dissection of the inguinal floor in the Bassini/Shouldice repair and 3) infection and chronic groin pain following mesh repair. The successful management of any problem depends on the understanding of its patho-physiology. In this context, some questions related to the physiology of the inguinal canal or factors that prevent herniation still exist. Lateral and cephalad displacement of the internal ring beneath the transversus abdominis muscle and approximation of the crura results in a shutter mechanism at the internal ring.[1] When the arcuate fibers of the internal oblique and transversus abdominis muscle contract, they straighten out and move closer to the inguinal ligament (shutter mechanism at the Published: 16 April 2003 BMC Surgery 2003, 3:2 Received: 16 November 2002 Accepted: 16 April 2003 This article is available from: http://www.biomedcentral.com/1471-2482/3/2 © 2003 Desarda; licensee BioMed Central Ltd. This is an Open Access article: verbatim copying and redistribution of this article are permitted in all media for any purpose, provided this notice is preserved along with the article's original URL.