Topic: Our Surgeons
This is a sketch of the hernia-vulnerable area of the Right groin (the egg-shaped region near the center of the drawing), and is called the Myopectineal Orifice of Fruchaud(MPO). Note specifically that the MPO is neither fully nor efficiently covered or reinforced by muscle layers, but is simply a layer of non-muscular Connective Tissue called "Transversalis Fascia", which consists of two thin, adherent semi-layers. The MPO is bordered above by the arching fibers of the internal oblique and transversus abdominus muscles. Medially (towards the center or to the right) by the Rectus Abdominus muscle, Inferiorly by Coopers Ligament and Laterally by the Ileopsoas Muscle. The structure running through the center of the MPO, from end to end, is the Inguinal Ligament, and it runs from the anterior-superior iliac spine (on the left of the photo) to the pubic tubercle. |
The oval structure in the upper half of the MPO represents the Internal Inguinal Ring.
Now lets think of the MPO like a 'frozen lake' (photo at left) at the center of which is a puddle (or Hole)in the ice. Think of a hernia as a 'Hole' in the ice on a frozen lake. Many surgeons' concept of a hernia is simply this, a HOLE in the abdominal wall that must be addressed (i.e., plug it up or sew it closed and that's that!!). But look closely at the Photo. The Puddle, or "Hole", is surrounded by an area of "THIN ICE". So too, a hernia, be it direct or indirect or even femoral, cannot be considered simply as the visable hole. It is always surrounded by an area of weakened, thinned-out, clinically significant and more likely hernia-prone fascia: This is the entire Transversalis Fascia of the MPO.
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