The Septum Inguinalis: A Clue to Hernia Genesis? (2025)

The functional repair of inguinal hernia

Hernia, 1997

Surgeons have not yet satisfactorily solved the problem of inguinal hernia, as is demonstrated by the high percentage of recurrence in subiects operated outside specialist units. An original method is proposed here. It does not require prostheses, conserves the cremaster muscle and modifies the anatomy of the inguinal region in a way that reconstitutes the defence mechanisms (sphincter and shutter) which are frequently incompetent in hernia patients. From December 1988 to December 1996 the operation has been performed on 1487 primary hernias, lO24 were systematically followed up: there were 6 recurrences (0.5%). The method is innovative in that it is the only one that simultaneously takes into account the principles of statics, biology and physiology. In spite of its apparent complexity, each stage is very dear. This makes the technique suitable for less expert surgeons.

Rare Inguinal Hernia Cases with Minimal Dissection

https://www.ijrrjournal.com/IJRR_Vol.6_Issue.7_July2019/Abstract_IJRR0023.html, 2019

Inguinal hernias are the most common type of hernia. These hernias result through a weak spot or tear in the lower abdominal wall, often in the inguinal canal. The main aim of the study is to assess the rare cases after the surgery of inguinal hernia. Data extracted from these papers included authors, country, year of publication, age and sex of patients, epidemiology, pathogenesis, risk factors for development of inguinal hernias, racial distribution, presenting symptoms, surgical treatment and unusual findings in inguinal hernia surgery were included in the study. Unusual cases of Inguinal Hernia Surgery and Risk factors for reoccurrence of Inguinal Hernia were discussed in the present study correlating it with the similar studies done in the past in various parts of the world. It may be concluded that even though hernia is a common surgical problem, up to date knowledge of herniology is important for proper repair of inguinal hernias to reduce recurrence rate, and careful handling of these unusual contents of inguinal hernias, to avoid damage to some of these structures.

Damage to the vascular structures in inguinal hernia specimens

2012

Background Few scientific reports to date describe the histological modification of structures outlining a hernia opening. This article is focused on the identification of the pathological changes in vascular structures in tissues excised from cadavers with inguinal hernia. A deeper comprehension of this topic could lead to essential improvements in the detection of hernia genesis. Materials and methods Different kinds of hernia, including indirect, direct and mixed, were identified in 30 autopsied subjects. Tissue samples were resected for histological study from abdominal wall structures close to the hernia opening. Histological examination focused on the detection of structural changes in arteries and veins. The results were compared with tissue specimens excised from equivalent sites of the inguinal area in a control group of 15 fresh cadavers without hernia. Results Significant modification of vascular structures were identified in the tissue specimens examined. The veins demonstrated parietal fibrosis, perivascular edema and vascular dilation due to congestion and stasis. The arterial structures detected showed thickening of the media due to medial hyperplasia, ranging from luminal subocclusion to a manifest artery occlusion. These findings are present independent of hernia type in cadavers with inguinal hernia. These pathological changes were lacking in the control group of cadavers without hernia. Conclusions The notable changes in vascular structures described in the report could be the result of a steady compressive effect exerted by the abdominal viscera in the inguinal area. These pathological changes could represent one of the factors involved in the weakening of the inguinal region leading to hernia protrusion.

Combined inguinal hernia in the elderly. Portraying the progression of hernia disease

International journal of surgery (London, England), 2016

Identification of a combined hernia is a common occurrence in the course of inguinal hernia repair. This type of protrusion disease seems to affect the elderly, in particular. Very few investigations have been carried out to ascertain the structural changes that occur in the groin affected by this clinical condition. Analysis of intraoperative findings of combined inguinal hernias evidenced in the elderly, from the most recent 100 groin hernia repair procedures carried out by a single operator, represents the basis of the article. Protrusions that presumably represent the forerunner of this type of hernia were also analyzed: double ipsilateral inguinal hernias composed of a direct and an indirect protrusion. The gross anatomical, as well as histological, modifications occurring during the development of combined protrusions were also evaluated. Combined hernia was the most frequent protrusion in patients over 65 years, accounting for 36% of the total in this patient group. In the sa...

Enigmatic aetiology of inguinal hernia

International Surgery Journal, 2019

The aetiology of inguinal hernia continues to be a topic for debate. A wide range of hypothesis have been postulated over a period of time. These are based on genetic factors, tissue configuration, biochemical enzymatic activity and anatomical structural weaknesses. None of these except the anatomical basis has helped in the evolution of hernia surgery. The article reviews the contemporary hypothesis postulated for the aetiology of inguinal hernias.

Etiology of inguinal hernia: ultrastructure of rectus sheath revisited

Hernia, 2006

In the last decade, in the search for abdominal-wall hernia etiology, attention has been brought to alterations in the connective tissue ultrastructure as the probable etiological factor. These may cause weakening of connective tissue, which in turn may form ground for hernia formation. To investigate this hypothesis in depth, we compared the ultrastructure of the connective tissue in hernia patients and the control group. The study group consisted of five patients with primary inguinal hernia (Nyhus II = 4, Nyhus IIIa = 1). Another five patients posted for emergency appendectomy created the control group. Tissue specimens, harvested intraoperatively from the rectus muscle sheath (RAMS) and fixed in 4% glutaraldehyde, underwent staining by the Masson, H-E and methylene blue techniques and were assessed by microscopy (light and scanning electron). The examinations showed significant differences in the rectus sheath ultrastructure. They included altered architecture, placement and quantity of collagen and elastic fibers, differences in the caliber of individual fibers and disrupted ground matter–to–fiber ratio. In patients with hernias, chaotic arrangement of collagen fibers was seen, as well as their thinning and a decrease in the general amount of elastic fibers, replaced by ground matter. Our research has shown significant differences in the structure of the RAMS between patients with hernias and healthy individuals. This supports the theory linking connective tissue alterations with the etiology of hernia, and stating that these alterations include connective tissue at locations distant from the hernia site as well, as the rectus sheath itself does not form a hernial defect.

Etiology of Inguinal Hernias: A Comprehensive Review

Frontiers in Surgery, 2017

Background: The etiology of inguinal hernias remains uncertain even though the lifetime risk of developing an inguinal hernia is 27% for men and 3% for women. The aim was to summarize the evidence on hernia etiology, with focus on differences between lateral and medial hernias. Results: Lateral and medial hernias seem to have common as well as different etiologies. A patent processus vaginalis and increased cumulative mechanical exposure are risk factors for lateral hernias. Patients with medial hernias seem to have a more profoundly altered connective tissue architecture and homeostasis compared with patients with lateral hernias. However, connective tissue alteration may play a role in development of both subtypes. Inguinal hernias have a hereditary component with a complex inheritance pattern, and inguinal hernia susceptible genes have been identified that also are involved in connective tissue homeostasis. Conclusion: The etiology of lateral and medial hernias are at least partly different, but the final explanations are still lacking on certain areas. Further investigations of inguinal hernia genes may explain the altered connective tissue observed in patients with inguinal hernias. The precise mechanisms why processus vaginalis fails to obliterate in certain patients should also be clarified. Not all patients with a patent processus vaginalis develop a lateral hernia, but increased intraabdominal pressure appears to be a contributing factor.

Histological findings of the internal inguinal ring in patients having indirect inguinal hernia

Hernia, 2009

Background Aiming to deepen the understanding of the factors involved in the genesis of groin hernia, this study is focused on identifying the histological changes within the muscle fibers of the internal inguinal ring in patients having indirect inguinal hernia. Methods In eight patients with primary or recurrent bilateral indirect inguinal hernia who underwent a Stoppa open posterior inguinal hernia repair, a tissue specimen from the edge of the internal inguinal ring was biopsied and histologically examined. Results In all of the tissue samples, remarkable degenerative changes such as fibrohyaline degeneration of the muscle fibers, vascular congestion, and phlogistic infiltration through lymphohistiocytary elements was constantly detected. Also, in the patients with recurrent hernia, the key characteristic of the muscular change was that of fibrohyaline and, occasionally, myxoid degeneration of the myocytes. Nerve endings were frequently detected within the muscular structures of the internal inguinal ring. Conclusion The degenerative fibrohyaline alteration, as well as the evidence of phlogistic elements within the examined structures, could represent a reason for a contractile incompetence of the internal inguinal ring. Consequently, the described findings lead the authors to depict this inflammatory degenerative structural weakness of the internal inguinal ring as a possible culprit of indirect inguinal hernia formation.

Modern Approach in Inguinal Hernia : A Review

2018

Introduction: In modern medical science, inguinal hernia still is a one of the main surgical problem with its various unexpected outcomes. But there is still a surgical dilemma for even the skilled surgeon, when it presents with some unusual contents. At the point of decision making, watchful waiting or go for surgery is common debate. is it better to go with mesh based surgery or suture based are also kind of another debate, and various study and authority favor and focus on various results. Watchful waiting used to be an acceptable strategy for minimally symptomatic hernia; many recent studies are contradictory in that decision because there are huge complications in emergency surgeries. The definitive treatment of inguinal hernias, regardless of their origin or type, is surgical repair. Various types of surgical corrections are fit in different presentations; hence the main decision point of surgery is surgeon’s skills, knowledge and update towards recent studies. Objectives: Our...

Inguinal hernia: State of the art

A review of the history of inguinal hernia repair from the far surgical approach performed by Celso, trought the physiological reconstruction of inguinal canal by Bassini and the introduction of the concept of tensionfree repair, to the newest find in this specialist surgery. Nowadays in addition to the choice of approach (open vs laparoscopic, anterior vs preperitoneal), the plane where placing the mesh (in front of the trasversalis fascia vs preperitoneal space), and the fixation device (suture vs sutureless vs glue), surgeons can select among a wide range of prosthesis. Choosing the proper biomaterial can determine the success of an operation and prevent biomaterial-related complications. Indepth knowledge and understanding of the physical properties of the pros-thesis, porosity, and pore size in particular are required. Modern advances in hernia repair are credited with reduced recurrence rate, so surgeons' attention is shifted from preventing recurrence to the new topic of chronic pain after surgery.