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

 

Iliopubic Tract Hernia Repair: 22

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

   
 

The lowest fibers of the external oblique aponeurosis form the shelving edge of the inguinal ligament. The medial fibers reflect back onto the pectineal ridge of the pubis. The thickened periosteum of the pectineal ridge is called the pectineal "ligament" (Cooper's ligament). The triangular fan of reflected fibers is the lacunar ligament. The posterior edge of the inguinal ligament is adherent to the iliopubic tract. Transversalis fascia (reflected back here) covers pectineal ligament and part of lacunar ligament. The rectus abdominus muscle narrows toward its origin on the pubis, and has a variable lateral tendinous expansion called Henle's ligament.     

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Iliopubic Tract Hernia Repair: 23

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

   
 

The medial part of the transversus abdominis muscle becomes aponeurotic, contributing to the deep lamina of the anterior rectus sheath (no posterior sheath below the arcuate line). The lower arched edge of the transversus also is aponeurotic and is called the transversus aponeurotic arch. It is a key part of the falx (sickle, L.) inguinalis and a strong medial anchor for anatomic hernia repair. It is fused to the underlying transversalis fascia, giving it added strength.      

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Iliopubic Tract Hernia Repair: 24

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

   
 

The internal oblique also is aponeurotic medially and is the second component of the deep lamina of the anterior rectus sheath. It is this fused aponeurosis that is incised as a relaxing incision in a McVay hernia repair. The lower edge of the lateral portion of internal oblique is not aponeurotic and has little intrinsic strength. The medial portion at the edge of the rectus muscle, however, is aponeurotic, and fused to the underlying transversus aponeurosis in about 1/4 of individuals (Anson and McVay). If fused, this structure is called the conjoined tendon. The conjoined tendon is also part of the falx inguinalis. Inferior extensions of the conjoined tendon may join with reflected fibers of the inguinal ligament over the pubis behind the spermatic cord.    

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This page was last modified on 8/15/2000.