Concepts that Prevent Inguinal Hernia Formation – Revisited New Concepts of Inguinal Hernia Prevention

The author was not satisfied with the present concept about the strength of the transversalis fascia that is said to prevent inguinal hernia formation in the normal individuals. Therefore, this study was conducted to see the anatomical status of transversalis fascia and presence or absence of aponeurotic extensions in the posterior wall of the inguinal canals as were described by some stalwarts like Condon, Nehus etc. Methods: This is a prospective study of 30 inguinal canals opened for inguinal hernia surgery and 30 for varicocoele or lipoma of the cord (No hernia) surgery from January 2007 to December 2012. Inguinal canals were opened under local anesthesia and without any sedation. Lipoma were excised, varicocoele ligated and the hernia repaired by authors technique [1]. Observations were made about the structure of the inguinal canal, more particularly the posterior wall. Results: 30 inguinal canals opened for lipoma or varicocele surgery without hernia showed full cover of the aponeurotic extensions of varying density and out of 30 inguinal canals opened for hernia surgery, 24 did not show presence of the aponeurotic extensions and 6 canals showed deficient or scanty aponeurotic extensions. None of them had full cover of the aponeurotic extensions. Thin and tiny Aponeurotic fibers seen in the posterior wall of the patient were treated as absent Aponeurotic extensions. Conclusions: Transversalis fascia does not have any role in the prevention of inguinal hernia formation. Aponeurotic extension in the posterior wall is the principle factor that prevents the inguinal hernia formation.