Anatomical Features and Measuring of the Approximate Muscle Tension in the Course of Selection of a Method of Inguinal Hernias Repair

Hernia repair represents the most frequent surgical operation. The objective of the research is determination of anatomical features of the inguinal canal and measuring of the approximate muscle tension as well as justification of the relaxing incision application in the process of the hernia repair in this region. The research is based on the prospective study including 120 patients, who underwent the operation in the General Hospital in Berane. 60 of them went through measuring of the inguinal canal length, referential angle (α), overlapping of musculoaponeurotic arch with m.rectus abdominis (H), distance between the arch and inguinal ligament (L) as well as measuring of the surface of myopectineal orifice (P1) and deep opening of the inguinal canal (P2). Approximate muscle tension was also measured before and after the relaxing incision. Control group was treated using conventional methods without previous measurements. Percentage of relapse was 6,6% in that group. The measured values were correlated. Inguinal canal length was in the range from 4,5 to 5,5 cm (64%). The average value of appendage (H) was 0,52 cm ± 0,34. Referential angle was 116,26 ± 1,68. The average value P1 was 9,75 cm ± 2,66. Surface of the deep opening P2 was 1,71 cm ± 1,07. The average values of approximate tension (N) before relaxing incision were I=19,9; II=22,4; III=21,7; IV=20,7; V=18,0, and after the relaxing incision the average values were I=15,7; II=17,6; III=16,7; IV=15,5; V=13,2. Referential angle (α) and distance of the musculoaponeurotic arch (L) from the inguinal ligament were measuring parameters, which indicated presence of tissue tension in the course of suture material placement. Approximate tension decreased after the relaxing incision and it reached maximum at the farthest distance L. Relaxing incision was obligatory. Local anesthesia was a matter of choice. Acta Medica Medianae 2006:45(4):15-22.