What makes up inguinal canal

The gubernaculum is attached to the ovaries and the anterolateral abdominal wall. During development, though, it also attaches in the middle to the uterus. This attachment to the uterus prevents the ovaries from being pulled down. It also results in an adult derivative of the gubernaculum with two parts: the ovarian ligament and the round ligament. The former is between the ovary and the uterus, the latter between the uterus and the labium majus, running through the inguinal canal.

It should be noted that, at the time of birth, the inguinal canals run almost entirely posterior to anterior, with little medial deviation. With growth and development into an adult, they assume their oblique arrangement. See an animation of this process here. The basic idea is that there are five folds covering ligaments and some spaces, or fossae, around and between them.

While not extremely important clinically, they do provide another way to think about the possible locations of hernias. Furthermore, these structures are interesting from the viewpoint of development, i. The boundaries of the inguinal canal must be understood to comprehend the principles of hernia repair.

In the inguinal canal, the anterior boundary is the external oblique aponeurosis; the posterior boundary is composed of the transversalis fascia with some contribution from the aponeurosis of the transversus abdominis muscle; the inferior border is imparted by the inguinal and lacunar ligaments; and the superior boundary is formed by the arching fibers of the internal oblique musculature.

The internal or deep inguinal ring is formed by a normal defect in the transversalis fascia through which the spermatic cord in men and the round ligament in women passes into the abdomen from the extraperitoneal plane.

The external or superficial ring is inferior and medial to the internal ring and represents an opening of the aponeurosis of the external oblique. The spermatic cord passes from the peritoneum through the internal ring and then caudally into the external ring before entering the scrotum in males. From superficial to deep, the surgeon first encounters Scarpa's fascia after incising the skin and subcutaneous tissue. Deep to Scarpa's layer is the external oblique aponeurosis, which must be incised and spread to identify the cord structures.

The inguinal ligament represents the inferior extension of the external oblique aponeurosis, and extends from the anterior superior iliac spine to the pubic tubercle. The medial extension of the external oblique aponeurosis forms the anterior rectus sheath. The iliohypogastric and ilioinguinal nerves, which provide sensation to the skin, penis, and the upper medial thigh, lie deep to the external oblique aponeurosis in the groin region. The internal oblique aponeurosis is more prominent cephalad in the inguinal canal, and its fibers form the superior border of the canal itself.

The cremaster muscle, which envelops the cord structures, originates from the internal oblique musculature. The transversalis abdominis muscle and its fascia represent the true floor of the inguinal canal.

Deep to the floor is the preperitoneal space, which houses the inferior epigastric artery and vein, the genitofemoral and lateral femoral cutaneous nerves, and the vas deferens, which traverses this space to join the remaining cord structures at the internal inguinal ring.

Figure legend: Direct inguinal hernia. Inguinal canal opened and spermatic cord retracted inferiorly and laterally to reveal the hernia bulging through the floor of the Hesselbach triangle. Which nerve travels with the spermatic cord, entering the inguinal canal at the internal ring, and exiting at the external ring?

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The type of surgery you have depends on which method suits you, and your surgeon's experience. You should be able to go home the same day or the day after surgery. It's important to follow the instructions you're given while in hospital about how to look after yourself. This includes eating a good diet to avoid constipation, caring for the wound, and avoiding strenuous activities.

Most people make a full recovery from inguinal hernia repair within 6 weeks, with many being able to return to work and light activities within 2 weeks.

Ask your surgeon or GP for advice on when it's safe for you to drive again. You should also speak to your insurer before driving again after having surgery. An inguinal hernia repair is a routine operation with very few risks. But a small number of hernias can come back at some point after surgery.

Complications are more likely if you're aged over 50, smoke or have another illness, such as heart disease or breathing problems. Page last reviewed: 15 October Next review due: 15 October What is an inguinal hernia? For information on other types of hernia , see: femoral hernia hiatus hernia umbilical hernia What causes an inguinal hernia?