The lateral triangle of the groin

Abstract

The lateral triangle (LT) of the groin is an area that includes the deep inguinal ring (DIR), and the tissues immediately lateral to it. It is vulnerable to develop recurrent indirect inguinal and interstitial hernias. An interstitial hernia is one in which the sac burrows through or between muscular layers. One typically presents as a palpable bulge at the lateral aspect of a prior inguinal incision; and it becomes more evident when the patient does a Valsalva maneuver. A review was done of our personal, single-center, four-year, series of recurrent inguinal hernia repairs. It showed that preference for a new site of recurrent hernia occurred when many open and laparoscopic mesh-repairs failed. Lateral failure following open-mesh repair (OMR) was related to using mesh to plug or cover the defect(s) of a primary or a recurrent hernia. Failure of laparoscopic hernia repair (LHR) typically was due to inadequate coverage lateral to the DIR. In a consecutive series of 3216 inguinal hernias repaired by the authors, 2768 were primary hernias, and 452 were 1X-4X recurrent hernias. Mesh had been used in groups of 28 prior LHR, and 20 prior OMR. The location of recurrences following any of the classical anterior open non-mesh repairs, i.e. Bassini, Halsted, McVay, Shouldice (ONMR), OMR, and LHR is compared. Based on our findings, we conclude that muscular weakness in the LT of the groin, coupled with mesh placed in the medial triangle of the groin, is the major cause of interstitial recurrent inguinal hernias.