INGUINAL ANATOMY

  • 1 January 1979
    • journal article
    • research article
    • Vol. 128  (MAY) , 581-594
Abstract
An account of the anatomy of the human inguinal region is presented which differs in many respects from accepted teaching. The pectineal ligament of Astley Cooper is attached not only to the pecten pubis but also to the pelvic brim. The inguinal ligament, pointed laterally and broad medially, gains its great strength from the oblique entry into it of the external oblique aponeurosis fibers. The lacunar ligament, derived from fascia lata, passes back from the inguinal ligament to fuse with the fascia over the pectineus muscle 1-1.5 cm below Cooper''s ligament. This results in a deep groove, the femoral trough, behind the posterior inguinal wall, in which lies the transversely placed femoral canal. The lacunar ligament curved edge is fixed, not high up to Cooper''s ligament, but around the femoral sheath venous compartment at the level of the inguinal ligament. This attachment prevents the femoral canal from entering the thigh. Thus a 3rd or medial compartment of the femoral sheath extending into the thigh between the lacunar ligament curved edge and the femoral vein does not exist. The valve of the U-shaped deep inguinal ring, described by Hesselbach in 1816, provides a passive and active defense against an oblique inguinal hernia. The ring is not the inert round or slit-like opening, usually described.