c l i n i c a l f o l i o s : n a r r a t i v e





A D V E R T I S E M E N T

 

Anterior Inguinal Hernia Repair: 4

A D V E R T I S E M E N T

   
 

If an anatomical (non-prosthetic) repair is to be done, the falx can be blindly plicated down to the iliopubic tract (loosely called a modified Bassini repair), or the floor can be opened for direct visualization of these structures.

 

There is no natural opening at the deep ring where the transversalis fascia of the ring is continuous with the internal spermatic fascia. Therefore an opening is made in the thin transversalis layer at the medial side of the cord just over the inferior epigastric vessels.     

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Anterior Inguinal Hernia Repair: 5

A D V E R T I S E M E N T

   
 

The transversalis fascia is opened from the deep ring to the edge of the rectus muscle, leaving a one centimeter strip of iliopubic tract above the inguinal ligament. When the medial flap of transversalis fascia is peeled up off the properitoneal fat, the white arch of falx is exposed.      

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Anterior Inguinal Hernia Repair: 6

A D V E R T I S E M E N T

   
 

An iliopubic tract (Shouldice) tract repair is done by suturing the reflected edge (falx) of the medial flap to the iliopubic tract as a first layer and the free edge of transversalis fascia to iliopubic tract and inguinal ligament as a second layer.      

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This page was last modified on 1/31/1999.