Reassessment of groin anatomy during the evolution of preperitoneal hernia repair

Condon, Robert E.

doi:10.1016/s0002-9610(96)00056-6

Cited by 22 publications

(7 citation statements)

References 6 publications

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“…However there are some reports claiming that these tendons do not actually insert on pubic tubercle but on rectus sheath well above the pubic tubercle. Therefore constant straining in athletes does not always produce shearing at the tubercle and symphisis level but more commonly produces shearing at the level of external inguinal ring [7,11]. Such findings correlate with intraoperative findings of Gilmore and other authors performing herniorraphies for sportsman hernias claiming that the cause of pain is an abnormality in the external inguinal ring.…”

Section: Introductionmentioning

confidence: 73%

“…With the complex anatomy of the groin region at the junction of three regions, findings on fresh cadaver dissections speak in favour of a common aetiology [7,8], that is, an overuse syndrome of this muscle to bone junction that is dependant on duration and type of sports, and produces different predominant pathological findings [9,10].…”

Section: Discussionmentioning

confidence: 99%

“…Enthesopathy at the site of insertion of the abdominal and the adductor muscles to the pubic bone has been described as another important cause of groin pain [5,6]. The adductor longus and the gracilis are generally affected as well as the rectus abdominis, the pyramidalis and the lateral aponeurosis of the abdominal external oblique, although not as frequently [5,7,8].…”

Section: Introductionmentioning

confidence: 99%

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Surgical treatment of chronic groin pain in athletes

Dojčinović

Sebecic

Silva

et al. 2012

International Orthopaedics (SICOT)

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Purpose Conservative treatment of chronic groin pain is prolonged and recurrence is quite common. Coexistence of sports hernia and adductor tendinitis/tendinosis in a single patient is noted in the literature. In our study we evaluated our operative treatment that should enable pain elimination and fast return to sports activities. Methods We performed a prospective study over a six-year period. Ninety-nine (99) patients, all male, with chronic groin pain, resistant to conservative treatment, underwent a surgical procedure. Results Seventy athletes with sports hernia returned to sports in an average 4.23 weeks (range three-16). Adductor tendinosis symptoms were present in 24 patients (2 %) with sports hernia. Twenty-four patients that had an additional adductor tenotomy performed returned to sports in an average 11.6 weeks (range ten-15). Five patients with isolated adductor tendinosis (7 %) returned to sports in an average 13.4 weeks (range 12-16). All athletes except two (2.8 %) treated for sports hernia were satisfied with the results of treatment and could continue their previous level of activity. Conclusion Any surgical procedure used for treating chronic groin pain should address the common causes of pain in this region. Adductor tendinosis can be present in up to 24.2 % of cases with sports hernia or may be isolated in 7 % of cases with chronic groin pain and must be treated by tenotomy. Resection of the genital branch of genitofemoral nerve and ilioinguinal nerve neurolysis should also be performed in patients with sports hernia.

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Section: Introductionmentioning

confidence: 73%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Surgical treatment of chronic groin pain in athletes

Dojčinović

Sebecic

Silva

et al. 2012

International Orthopaedics (SICOT)

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“…[60] A definite need to define accurately groin anatomy as visualized by the preperitoneal approach cannot be really overemphasized. [61] Confusions and misunderstandings are continued regarding the extraperitoneal fascial tissues among the practicing surgeons and anatomists alike since the time (1804) of Sir Astley Paston Cooper. [22,24,31,32,49,62] Even direct examination of the live surgical anatomy under excellent perspective and high magnification with clear definition of the various fascial planes under the focused bright lighting of the intraperitoneal and preperitoneal laparoscopy did not help much to alleviate the ever prevailing confusions and misunderstandings/ misinterpretations, and little/no agreement exists among the practicing surgeons and anatomists regarding the interparietoperitoneal fascial tissues, especially the transversalis fascia and the preperitoneal fascia.…”

Section: Discussionmentioning

confidence: 99%

Transversalis Fascia and Preperitoneal Fascia: A Laparoscopic Study of Live Surgical Anatomy during TEPP Hernioplasty – Final Report and Literature Review

Ansari¹

2017

AIMDR

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Background: Despite excellent perspective, bright lighting and high magnification afforded by preperitoneal laparoscopy, there is still little agreement among the practicing surgeons and anatomists about transversalis and preperitoneal fascias. Methods: Study Setting -Elective Clinical; Design -Prospective; Population -Adults (≥18 years); Place -J. N. Medical College Hospital, A. M. U., Aligarh; Procedure: Laparoscopic total extraperitoneal preperitoneal (TEPP) hernioplasty; Technique: Standard 3-midline-port technique; Method: Telescopic and instrument dissection; Data collection -Intraoperative documentation and/or video recording; Data analysis -SPSS (v. 21).Results: Sixty eight TEPP hernioplasties (Unilateral TEPP 52; Bilateral 8) were successful in 60 patients. Transversalis fascia was of three types -single diaphanous layer (60%), single membranous layer associated with little/no fat (15%) and thin flimsy layer (25%). Preperitoneal fascia was observed as a definite single membranous layer in 83% of the cases, and as a double membranous layer in the remaining 17%. Internal spermatic fascia was found as an extension analog of the preperitoneal fascia in all cases in the present study, with formation of a secondary internal inguinal ring at its beginning. Easily fissile avascular plane was consistently present between preperitoneal fascia and transversalis fascia, suggesting different embryological origins. Conclusion: Preperitoneal laparoscopy of inguino-pelvic region confirmed regular presence of easily recognizable preperitoneal fascia distinct from transversalis fascia in all cases, with an easily fissile avascular preperitoneal plane in between them. Transversalis fascia was invariably unilaminar but preperitoneal fascia was at times bilaminar. Instead of transversalis fascia, preperitoneal fascia formed internal spermatic sheath with a secondary internal inguinal ring.

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“…Serous fluid accumulates to form an infantile hydrocele; d. The midportion of the processus is unclosed, forming a cyst (cystic hydrocele); e. Normally closed processus. In several recent publications, a number of authors [Hutson 1994, 1996, Heyns 1995, Clarnette 1996 considered various concepts about testicular descent (including two independent steps in which they place the first phase between the 8th and 15th weeks of gestation and the second phase between the 28th and 35th weeks).…”

Section: Fig 11 A-fmentioning

confidence: 99%

The embryology of the inguinofemoral area: an overview

Skandalakis

Colborn

Skandalakis

1997

Hernia

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This paper is an essay to understand the formation of the inguinal and femoral areas by means of an overview of the embryogenesis of the anterior abdominal wall below the umbilicus, as well as by examining the genesis and the descent of the gonads.Developmental considerations of the femoral canal lead to a discussion of the potential explanations for the developmental formation of a femoral hernia sac. The main argument against the congenital origin of femoral hernia is its rarity in infants and children. Despite the lack of irrevocable proof of a developmental defect, femoral hernias do occur in children and they can become strangulated. Some attractive embryological theories which attempt to explain this fact are discussed.

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Reassessment of groin anatomy during the evolution of preperitoneal hernia repair

Cited by 22 publications

References 6 publications

Surgical treatment of chronic groin pain in athletes

Surgical treatment of chronic groin pain in athletes

Transversalis Fascia and Preperitoneal Fascia: A Laparoscopic Study of Live Surgical Anatomy during TEPP Hernioplasty – Final Report and Literature Review

The embryology of the inguinofemoral area: an overview

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