Where exactly is the deep inguinal ring in patients with inguinal hernias?
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It is difficult to distinguish direct from indirect inguinal hernias on clinical examination. This study attempted to determine an anatomical basis for this finding. Fifty adult patients with primary inguinal hernias were assessed. The position of the deep inguinal ring (DIR) was estimated from the position of the anterior superior iliac spine (ASIS) and the pubic tubercle (PT) pre-operatively and then the actual distance from these landmarks was measured intra-operatively. The DIR was actually located at a mean of 41% (95% confidence interval (CI) 26–56%) of the way along the inguinal ligament from the PT towards the ASIS (regression slope 1.203; 95% CI 1.141–1.127), compared with the 50% which would be expected from traditional clinical methodology. The DIR was actually found at a mean of 51% (95% CI 33–69%) of the way along a line from the pubic symphysis to the ASIS (regression slope 1.421; 95% CI 1.343–1.499). Pre-operative estimates of the position of the DIR are not accurate measures of its true position in patients with inguinal hernias. Clinical examination of inguinal hernias cannot rely on a constant position of the DIR to determine whether a hernia is direct or indirect.
KeywordsInguinal hernia Anatomy Clinical landmarks
- 1.Bland JM, Altman DG (1986) Statistical methods for assessing agreement between two methods of clinical measurement. Lancet I: 307–310Google Scholar
- 2.Borley NR (1997) Inguinal region—soft tissues 1. In: Clinical surface anatomy. Manson Publishing, London, pp 64–65Google Scholar
- 3.Browse NL (1997) Abdominal herniae. In: An introduction to the symptoms and signs of surgical disease, 3rd edition. Arnold, London, pp 321–325Google Scholar
- 5.Ellis H, Calne RY, Watson CJE (1998) Hernia. In: Lecture notes on general surgery, 9th edn. Blackwell Science, Oxford, pp 234–236Google Scholar
- 6.Ellis H, Dussek JE (1995) Surface anatomy. In: Bannister LH, Berry MM, Collins P, Dyson M, Dussek JE, Ferguson MWJ (eds) Gray’s anatomy, 38th edn. Churchill Livingstone, New York, p 1919Google Scholar
- 7.McMinn RMH (1994) Last’s anatomy, 9th edn. Churchill Livingstone, New York, pp 304, 154Google Scholar
- 8.Nyhus LM (1993) Individualization of hernia repair: a new era. Surgery 14: 1-2Google Scholar
- 11.Salmons S (1995) Muscles of the abdomen. In: Bannister LH, Berry MM, Collins P, Dyson M, Dussek JE, Ferguson MWJ (eds) Gray’s anatomy, 38th edn. Churchill Livingstone, New York, p 829Google Scholar
- 12.Talley, O’Connor (1992) The gastrointestinal system. In: Clinical examination, 2nd edn. Blackwell Scientific, Oxford, pp 167–168Google Scholar