Surgical and Radiologic Anatomy

, Volume 28, Issue 2, pp 121–124 | Cite as

Defining the position of deep inguinal ring in patients with indirect inguinal hernias

  • P. Sanjay
  • T. D. Reid
  • D. J. Bowrey
  • A. WoodwardEmail author
Original Article


A preliminary survey of surgeons of all grades in our hospital revealed confusion about the position of the deep inguinal ring. Standard teaching is that the deep inguinal ring is lateral to the femoral artery. The aim of this study was to define the position of the deep ring in patients undergoing elective inguinal hernia repair. Thirty consecutive male patients undergoing indirect inguinal hernia repair under local anaesthesia were studied. The following landmarks were marked on the patient with a felt pen: anterior superior iliac spine (ASIS), femoral artery (FA), deep inguinal ring (DR), pubic tubercle (PT) and pubic symphysis (PS). The distance of each point from the ASIS was measured in centimetres. The relation of the femoral artery to the deep inguinal ring was confirmed by palpation through the deep ring during surgery. The femoral artery was consistently identified midway between the anterior superior iliac spine and pubic symphysis (mid-inguinal point). The deep inguinal ring was located medial (22/30) or above (8/30) the femoral artery, but never lateral. The mean distances from the anterior superior iliac spine to the deep ring and femoral artery were 8.8 and 7.7 cm, respectively. Contrary to standard teaching, this study demonstrates that the deep inguinal ring lies medial, not lateral, to the femoral artery. This may clarify some of the variations in textbook anatomy, and explain the difficulty in distinguishing direct and indirect inguinal hernias pre-operatively.


Deep inguinal ring Inguinal hernia Anatomy 


  1. 1.
    Abrahams PH, Hutchings RT et al (1998) McMinn’s colour atlas of human anatomy.4th edn. Mosby, LondonGoogle Scholar
  2. 2.
    Agur AMR, Lee MJ. (1999) Grant’s atlas of anatomy. 10th edn. Lippincott Williams and Wilkins, PhiladelphiaGoogle Scholar
  3. 3.
    Andrews BT, Burnand KG, Ferrar D (1996) Putting a finger on the deep inguinal ring . J R Coll Surg Edinb 41:90–92PubMedGoogle Scholar
  4. 4.
    Bannister LH, Berry M et al (Ed) (1995) Gray’s Anatomy 38th Ed . Churchill Livingstone, New yorkGoogle Scholar
  5. 5.
    Campbell IR (1988) What is the surface marking of the deep inguinal ring? JR Coll Surg Edinb 33:247–248Google Scholar
  6. 6.
    Conaghan P, Hassanally D, Griffin M, Ingham Clark C (2004) Where exactly is the deep inguinal ring in patients with inguinal hernias? Surg Radiol Anat 26:198–201PubMedCrossRefGoogle Scholar
  7. 7.
    Ellis H. (2002) Clinical anatomy. 10th edn. Blackwell, BaltimoreGoogle Scholar
  8. 8.
    Flament JB, Avisse C, Delattre JF (1997) Anatomy and mechanism of inguinal hernias. Revue du Praticien. 47:252–255PubMedGoogle Scholar
  9. 9.
    Fruchaud H (1956) Anatomie Chirurgicale des Hernies de L, aine. G. Doin, ParisGoogle Scholar
  10. 10.
    Hafferl A (1969) Lehrbuch Der Topographischen Anatomie. Springer, Berlin Heidelberg New YorkGoogle Scholar
  11. 11.
    Koliyadan SV, Narayan G, Balasekran P (2004). Surface marking of the deep inguinal ring. Clin Anat 17:554–557PubMedCrossRefGoogle Scholar
  12. 12.
    Moore KL, Agur AMR. (1996) Essential clinical anatomy. Williams and Wilkins, BaltimoreGoogle Scholar
  13. 13.
    Parnis SJ, Roberts JP, Hutson JM (1997) Anatomical landmarks of the inguinal canal in prepubescent children. Aust N Z J Surg 67:335–337PubMedCrossRefGoogle Scholar
  14. 14.
    Ralphs DN, Brain AJ, Grundy DJ, Hobsley M (1980) How accurately can direct and indirect inguinal hernias be distinguished? BMJ 280:1039–1040PubMedCrossRefGoogle Scholar
  15. 15.
    Rintoul RF (Ed) (1995) Farquharson’s textbook of operative surgery. 8th Ed. Churchill Livingstone, EdinburghGoogle Scholar
  16. 16.
    Russell RCG, Williams NS et al (Ed) (2000) Bailey and Love’s Short practice of surgery 23rd Ed. Arnold, LondonGoogle Scholar
  17. 17.
    Snell RS (1995) Clinical anatomy for medical students. 5th edn. Little, Brown and Company, LondonGoogle Scholar
  18. 18.
    The Royal College of Surgeons of England (1993). Clinical Guidelines on the management of Groin Hernias in Adults. RCSE, LondonGoogle Scholar
  19. 19.
    Tondury G (1949) Angewandte Und Topographische Anatomie. Fretz & Wasmuth Verlag AG., ZurichGoogle Scholar

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • P. Sanjay
    • 1
  • T. D. Reid
    • 2
  • D. J. Bowrey
    • 3
  • A. Woodward
    • 4
    Email author
  1. 1.Clinical Research Fellow General SurgeryRoyal Glamorgan HospitalS. WalesUK
  2. 2.Senior House Officer in General SurgeryRoyal Glamorgan HospitalS. WalesUK
  3. 3.Specialist Registrar in General SurgeryRoyal Glamorgan HospitalS. WalesUK
  4. 4.Consultant in General SurgeryRoyal Glamorgan HospitalS. WalesUK

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