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Inguinal Region – Anatomy, Part 2

Anatomy of Inguinal Region

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.

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

  1. External iliac artery
  2. Inferior epigastric artery and its branches

Veins

  1. External iliac vein
  2. Inferior epigastric veins
  3. Deep venous circulation

Nerves

  1. Lateral femoral cutaneous nerve
  2. Genitofemoral nerve
  3. Femoral nerve
  4. Ilioinguinal nerve
  5. Iliohypogastric nerve
  6. Lymphatics and lymph nodes

-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).

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.

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

  1. Lateral femoral cutaneous nerve
  2. Femoral branch of genitofemoral nerve
  3. Obturator nerve

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

  1. Ilioinguinal nerve
  2. Iliohypogastric nerve
  3. Genital branch of genitofemoral nerve
Nerves in the Inguinal Region

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Contact Details

Dr. R. Padmakumar
MBBS, DNB, MNAMS, DipALS, FAIS, FIMSA, FCLS, FRCS (GL)
Senior Consultant Laparoscopic and Metabolic Surgeon &
Director - Verwandeln Institute (Transforming Lives)
(Specialist in Laparoscopy, Hernia, Cancer, Obesity Surgery or Bariatric Surgery, Diabetes Surgery, Endoscopic Thyroid Surgery, Thoracoscopy, Intragastric Balloon)
Keyhole Clinic, Metro Pillar no. 448, Edappally, Kochi, Kerala, India
VPS Lakeshore Hospital, Maradu, Kochi, Kerala, India
Past Chairman - Association of Surgeons of India, Kerala Chapter, 2019-2020

Address

Keyhole Clinic - Center for Obesity and Laparoscopy

Metro Pillar no. 448, Edappally, Kochi, Kerala, India

VPS Lakeshore Hospital

Maradu, Kochi, Kerala


Mobile: +919447230370, +919846320370
Email: [email protected]

Website:
www.drrpadmakumar.com

Past Chairman, Association of Surgeons of India - Kerala Chapter
National President - Indian Hernia Society (2016)
GC Member, Association of Surgeons of India (2013 - 2018)
Vice President- Society of Endoscopic and Laparoscopic Surgeons of India
Jt. Secretary - Indian Association of Endocrine Surgeons (2016)
Founder Member, Obesity and Metabolic Surgery Society Of India
Founder Member, Association of Minimal Access Surgeons of India
International Faculty of IASGO on Hernia and Diabetic Surgery
International Faculty of IFSO on Diabetic Surgery
Associate Editor : Diabetes and Obesity International Journal