Age‐related changes in inguinal region anatomy from 0 to 19 years of age

Abstract

Knowledge of the age-related changes in inguinal region anatomy is essential in pediatric urological and abdominal surgery, yet little is published. This study aimed to determine the position of inguinal region structures and growth of the surrounding pelvis and inguinal ligament in subjects from 0 to 19 years of age. Anonymized contrast-enhanced CT DICOM datasets of 103 patients (63 male: 40 female) aged from 0 to 19 years had left and right sides analyzed by three independent observers. Exclusion criteria were applied. Growth of the pelvis and inguinal ligament were determined using fixed bony reference points. The position of the deep inguinal ring and femoral vasculature were determined as ratio of inguinal ligament length, measured from the anterior superior iliac spine. Growth of the pelvis in vertical and horizontal dimensions and of the inguinal ligament followed a positive polynomial relationship with increasing age, with no observed increase in growth rate during puberty. From 0 to 19 years, the deep inguinal ring moved superolaterally with respect to the inguinal ligament (from 0.74 to 0.60 of the distance along the inguinal ligament) and the femoral artery and vein moved medially (from 0.50 to 0.58, and 0.61 to 0.65 of the distance along the inguinal ligament, respectively). The position of the femoral artery, vein, and deep inguinal ring followed a logarithmic relationship with age. No significant left:right side or male:female differences were observed. From 0 to 19 years of age the femoral vasculature and deep inguinal ring change position as the pelvis grows around them. Clin. Anat. 32:794-802, 2019.

No Reason to Use Mesh in Groin Hernia Repair in Adolescents

“…Traditionally, the hernia literature defines adults as 18 years and above, but there does not seem to be a well-founded anatomical or physiological reasoning for this lower age limit. On the contrary, growth of the pelvis and groin in healthy and well-nourished individuals can be expected to continue up to age 19 in both sexes [ 28 ]. To avoid implanting a synthetic foreign body like a mesh in a groin that is not fully grown, it is probably better to refrain from using mesh in patients who still have growth potential.…”

“…Final adult height can be expected to be reached at 19 years in males and at 17 years in females [ 26 , 27 ]. In contrast to stature, there is no acceleration of growth of the pelvis during adolescence as both horizontal and vertical growth of the pelvis and growth of the inguinal ligaments are relatively linear from 0 to 19 years of age [ 28 ].…”