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General Surgery
Inguinofemoral Area
Built from Skandalakis' Surgical Anatomy: The Embryologic and Anatomic Basis of Modern Surgery
What’s inside
11 sections · 189 slides
Overview
- Scope of the inguinofemoral area
The inguinal canal
- Inguinal canal in infants and children
- Newborn indirect inguinal hernia: operative implication
- Adult anatomy of the inguinal canal
- Inguinal canal: anterior and inferior formations with both rings
- The external inguinal ring
- Surgical anatomy of the internal inguinal ring
- Walls of the inguinal canal
- Surgical primacy of the posterior wall
- Parasagittal section through the right mid-inguinal region
- Normal posterior wall and the anatomy of a direct inguinal hernia
- Piriform fossa of the inguinal canal
- Piriform fossa popularised by Madden
- Myopectineal orifice of Fruchaud
- Coverings and traverse of the myopectineal orifice
- Reconstructed posterior wall and anterior view of the myopectineal orifice
- Contents of the spermatic cord
- Spermatic cord in the inguinal canal
- the Spermatic Cord and Its Covering
- the Spermatic Cord and Its Covering (continued)
- External oblique aponeurosis opened with the cord mobilised
Fasciae and ligaments of the groin
- Superficial fascia of the lower abdominal wall
- Camper's and Scarpa's fasciae and their continuations
- Fundiform ligament, dartos and Colles' fascia
- Superficial and deep fascial continuities of the penis and perineum
- Attachments of Scarpa's fascia
- Deep fascia of the anterior wall and the perineum
- Inguinal ligament of Poupart
- External oblique aponeurosis in the groin
- The conjoined tendon: definition and the problem
- Reported incidence of the conjoined tendon
- What is actually used in the operating room
- The conjoined area
- Ligament of Gimbernat, the lacunar ligament
- Lacunar ligament and the medial border of the femoral ring
- Doyle's objection to the term lacunar ligament
- Lacunar ligament partially covering the pectineal aponeurosis
- Compartments beneath the inguinal ligament with the pectineal and lacunar ligaments
- Cooper's ligament: competing definitions
- Cooper's ligament: further descriptions
- Cooper's ligament in practice
- Structures contributing to the pectineal ligament
- Insertion of the iliopubic tract into Cooper's ligament
- Arch of the transversus abdominis
- Ligament of Henle and the interfoveolar ligament
- Reflected inguinal ligament
- Iliopubic tract: names and origin
- Course and attachments of the iliopubic tract
- Distinguishing the iliopubic tract from the inguinal ligament
- Iliopubic tract and its relations to the genital branch of the genitofemoral nerve
- Pathway of the genital branch from the deep ring to the cord
- Transversalis fascia crura at the deep ring
- Iliopectineal arch
- The iliopectineal arch
Transversalis fascia, layers and preperitoneal spaces
- Cooper's original description of the transversalis fascia
- Transversalis fascia: modern definition and surgical value
- Transversalis fascia in the lateral and lower abdominal cavity
- Cross section of a strong posterior canal wall
- Bilaminar transversalis fascia: Cooper's posterior lamina
- Is the posterior lamina truly transversalis fascia?
- Old and new concepts of the transversalis fascia and femoral sheath
- Musculoaponeurotic laminae of the inguinal region
- Layers of the abdominal wall and inguinal area in section
- Abdominal wall layers and the paths of indirect inguinal hernia
- Space of Bogros
- Contents and dissection of the space of Bogros
- Venous circle of Bendavid
- Deep inguinal vasculature within the space of Bogros
- Variations in the deep inguinal venous system
- The aberrant obturator artery: the enemy below
- Superficial perineal cleft and the scrotum
- Blood supply and lymphatic drainage of the scrotum
Fossae, triangles and the sites of groin hernia
- Hesselbach's triangle
- Repair material within Hesselbach's triangle
- Hesselbach's triangle as originally described and as accepted today
- Peritoneal fossae and the hernia each produces
- Fossae of the lower anterior abdominal wall
- Fossae of the anterior abdominal wall and the sites of groin hernia
- Supravesical hernia and its landmark
- Pathways of external and internal supravesical hernia
The femoral region
- Compartments between the inguinal ligament and the iliopectineal line
- Variations of the femoral nerve
- Femoral sheath and femoral canal
- Femoral ring: dimensions and boundaries
- Femoral ring dimensions
- Contents of the femoral canal
- Site of obstruction in a strangulated femoral hernia
- Boundaries of the femoral ring and the femoral orifice
- Aberrant obturator artery in relation to a femoral hernia sac
- Bony elements of the inguinofemoral area
- Bony and ligamental elements of the inguinofemoral area
Vessels, lymphatics and nerves of the inguinal area
- Superficial arterial supply of the groin
- Deep arteries of the inguinal region
- Deep circumflex iliac artery
- Veins of the inguinal area
- Superficial inguinal nodes: the five zones
- Distribution of nodes within the zones
- Lymph node distribution around the great saphenous vein
- Deep and aberrant inguinal nodes
- Pathways of lymph from the groin
- Field of a radical inguinal lymphadenectomy
- Lymphatic tissue and the circle of death
- Nerves of the inguinal region
- Ilioinguinal nerve: terminal branches
- Variability of the ilioinguinal nerve
- Course of the ilioinguinal nerve
- Genitofemoral nerve: the two branches
- Entrapment of the genital branch at the deep ring
- Three pathways of the genital branch in the inguinal canal
- Other nerves at risk in the groin
Histology, physiology and surgical principles
- Collagen and the biology of hernia
- Wound healing in the posterior wall
- Integrity of the inguinal canal
- Sphincteric and shutter mechanisms
- Laparoscopic topographic anatomy of the inguinal region
- Surgical considerations and the range of repairs
- Material available for repair
- McVay's summary: fasciae and the inguinal ligament
- McVay on the superficial ring and the muscles
- McVay on the transversus abdominis and rectus sheath
- McVay on the femoral sheath and the principle of repair
- Stoppa's retroparietal spermatic sheath
- Prolongations of the urogenital fascia
- Intraoperative view of the right spermatic sheath
- Schematic of the retroparietal segment of the spermatic sheath
- Narrow and usual lateral extensions of the spermatic sheath
- Spaces of Retzius and Bogros in cadaver dissection
- Right Bogros space and iliac fossa in cadaver dissection
- Posterior aspect of the anterolateral wall and spermatic sheath
Laparoscopic anatomy of the inguinal area
- Laparoscopic dissection of the cadaver groin
- The bladder in the laparoscopic field
- Order of laparoscopic exposure
- Inferior epigastric vessels after incising the peritoneum
- Transversus arch, iliopubic tract and Cooper's ligament exposed
- Spermatic cord and iliac vessels after further cleaning
- Panoramic laparoscopic view of the inguinal area
- Laparoscopic layers, fossae and spaces of the inguinal area
- Landmarks visible and invisible from behind
- Peritoneal aspect of the right deep ring in a lean male
- Peritoneal aspect of the deep ring in an obese male with an indirect hernia
- Angle of the ductus and thickness of tissue at the deep ring
- Peritoneal fossae as seen laparoscopically
- Spaces entered laparoscopically
- Inguinofemoral anatomy in the preperitoneal approach
- Aberrant obturator vein avulsed at the external iliac vein
- Atypical femoral cutaneous nerve and aberrant obturator artery
- Nerves and vessels around the deep inguinal ring
- Vessels medial to and below the deep ring
- Vessels and nerves related to the iliopubic tract
- The three danger areas of the laparoscopic groin
- Triangle of Doom
- Triangle of Doom
- Triangle of Pain
- Triangle of Pain
- Circle of Death
- Circle of Death
- Avoiding injury to nerves and vessels
- Avoiding injury to organs
- Unpredictability of nerves over the iliacus
- Small nerves piercing the iliopubic tract
- Femoral nerve and deep circumflex iliac vessels laparoscopically
- Concealment of vessels by lymphatic tissue
The posterior lumbar wall
- The posterior abdominal wall
- Grynfeltt's versus Petit's triangle
- Lumbar hernia in practice
- Petit's and Grynfeltt's triangles and the paths of lumbar hernia
- Cross section of the posterior body wall in the lumbar region
- Herniation of the descending colon through the inferior lumbar triangle
Summary and references
- Key structural takeaways
- Key operative takeaways
- Terminology to use with care
- Sources cited in this account
- Sources cited in this account (continued)
- Sources cited in this account (continued)
- Sources cited in this account (continued)
- Sources cited in this account (continued)
- Sources cited in this account (continued)
- Skandalakis' Surgical Anatomy: The Embryologic and Anatomic Basis of Modern Surgery
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