|Posted on April 20, 2010 at 1:00 PM|
As far as groin hernias are concerned, Prof. Dr. Desarda has raised questions about the theories mentioned in the text books that prevent herniation. Obliquity of inguinal canal or shutter mechanism or high muscle arch or patent processus vaginalis, etc., are not the real factors that prevent hernia formation in the normal individuals. Chronic cough or job of weight lifting is also not real factor that cause hernia formation in the normal individuals. Because not every individual having bronchial asthma develop hernia nor every coolie on the railway platform develop hernia. It means these are not the real factors that cause hernia formation in the normal individuals. The real factor that prevents hernia formation in the normal individual is presence of aponeurotic extensions from the transversus abdominis aponeurotic arch in first place and strong musculo-aponeurotic structures around the inguinal canal in the second place. REF: Desarda MP. Surgical physiology of inguinal hernia repair. BMC Surgery 2003, 3:2 or visit website http://www.desarda.com email: [email protected]
Current inguinal hernia operations are generally based on anatomical considerations. Failures of such operations are due to lack of consideration of physiological aspects. Many patients with inguinal hernia are cured as a result of current techniques of operation, though factors that are said to prevent hernia formation are not restored. Therefore, the surgical physiology of inguinal canal needs to be reconsidered.
The successful management of any problem depends on the understanding of its patho-physiology. In this context, some questions related to the physiology of the inguinal canal or factors that prevent herniation still exist. Lateral and cephalad displacement of the internal ring beneath the transversus abdominis muscle and approximation of the crura results in a shutter mechanism at the internal ring. When the arcuate fibers of the internal oblique and transversus abdominis muscle contract, they straighten out and move closer to the inguinal ligament (shutter mechanism at the inguinal canal). This opposite movement (upward & downward) of the same muscle needs proper explanation. The term "obliquity of the inguinal canal" is not a perfect description since the spermatic cord is lying throughout its course on the transversalis fascia. Repeated acts of crying, thereby increasing the intra-abdominal pressure do not increase the incidence of hernia in new born babies in spite of the almost absent "obliquity of the inguinal canal" or "shutter mechanism". Similarly, every individual with a high arch or a patent processus vaginalis does not develop hernia. Factors that are said to prevent herniation are not restored in the traditional techniques of inguinal hernia repair and yet 70–98% of patients are cured. Then what are the additional factors that play a role in the prevention of hernia after surgery? Please visit our website for more details: http://www.desarda.com EMAIL: [email protected]
Categories: Inguinal hernia repair without mesh