Abstract
BackgroundCurrent 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.MethodsA retrospective study is describer of 200 patients operated on for inguinal hernia under local anaesthesia by the author's technique of inguinal hernia repair.ResultsThe 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.ConclusionsA 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.
Highlights
Current inguinal hernia operations are generally based on anatomical considerations
Aponeurotic extensions from the transversus abdominis aponeurotic arch were absent in the posterior wall in all patients
The absent aponeurotic extensions in the posterior wall were replaced with an aponeurotic strip of the external oblique aponeurosis (EOA) to give a strong and physiologically dynamic posterior wall in all patients
Summary
Current inguinal hernia operations are generally based on anatomical considerations. 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. 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. BMC Surgery 2003, 3 http://www.biomedcentral.com/1471-2482/3/2 inguinal canal).[2,3]. This opposite movement (upward & downward) of the same muscle needs proper explanation. Factors that are said to prevent herniation are not restored in the traditional techniques of inguinal hernia repair and yet 70–98% of patients are cured. What are the additional factors that play a role in the prevention of hernia after surgery?
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