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Inguinal Region – Anatomy, Part 2

Anatomy of Inguinal Region – Previous Page

Transversalis Fascia (of Gallaudet)

This fascia is a two layered structure (bilaminar). The anterior layer is adherent to the rectus abdominis muscle. The posterior layer lies in between the anterior layer and the peritoneum. It divides this space into an anterior (vascular space) and a posterior (Space of Bogros). Medially it is continuous with the space of Retzius. One should work in the space of Bogros to prevent unnecessory oozing.

Prevesical space of Retzius

The preperitoneal space that lies deep to the supravesical fossa and the medial umbilical fossa is the prevesical space of Retzius (Described in 1858, by Swedish anatomist Anders Retzius). This space contains loose connective tissue and fat.

Important structures in this space are:

Arteries

External iliac artery
Inferior epigastric artery and its branches

Veins

External iliac vein
Inferior epigastric veins
Deep venous circulation

Nerves

Lateral femoral cutaneous nerve
Genitofemoral nerve
Femoral nerve
Ilioinguinal nerve
Iliohypogastric nerve
Lymphatics and lymph nodes

Pubic branches:

-The inferior epigastric artery gives rise to anterior pubic artery, which accompanied with the iliopubic vein crosses the superior pubic ramus. In 25-30% of individuals, the anterior pubic branch is large and can replace the obturator artery. This large arterial branch (Aberrant obturator artery) can partially encircle the neck of a hernia sac and be injured in a femoral hernia repair. It could also be injured while dissecting on to the Cooper’s ligament. So the whole anastomotic ring is known as the – ‘Corona Mortis’ (circle of death) (10).

Deep venous circulation of the preperitoneal space (Bendavid): –

The venous circle/ deep venous circulation of Bendavid(11) is located at the subinguinal space of Bogros. It is a network of deep inferior epigastric, rectusial, suprapubic and retropubic veins. These are important because damage to these vessels is easy and usually leads to haematoma formation.

Nerves in the inguinal region: –

The following three nerves are at risk for injury during dissection-

Lateral femoral cutaneous nerve
Femoral branch of genitofemoral nerve
Obturator nerve

The following nerves are usually not at risk during dissection, but can be injured if excessive pressure is applied during mesh fixation.

Ilioinguinal nerve
Iliohypogastric nerve
Genital branch of genitofemoral nerve

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