Page 17 - herina surgery and possible lawsuits

lumborum, which may divide within the psoas muscles and pierces the
transversus abdominis muscles near the anterior superior iliac spine to run
between internal and external oblique muscles. Ilioinguinal nerve running

ventrally and parallel to the spermatic cord, behind the external oblique
aponeurosis and passes through the external ring to run with spermatic
cord while iliohypogastric nerve pierces the external oblique 2-5 cm above

the external ring to innervate the skin above the pubis.[37,38]
b) Genitofemoral nerve (LI, 2)- pierces the abdomen anterior to psoas, runs
behind the psoas fascia, which divides lateral to common and external iliac

vessels in to genital femoral branches. Genital branch is laterocaudal at the
level of the internal inguinal ring and runs with spermatic cord to innervate
the cremasteric fibers are derived from internal oblique muscles [37,38]

c) Lateral cutaneous nerve of thigh (L2,3)
d) Femoral nerve

APPLIED ANATOMY

1) Transversalis fascia is a layer m the make-up of the posterior inguinal wall.

It is the deepest, thinnest, and least important layer m terms of the
prevention of herniation. It is a segment of the wider endoabdominal fascia.
The true posterior wall of the inguinal canal is formed, in varying degrees,
by the muscles or aponeurosis of the internal oblique and transversus

abdominis. [3 9] Because of the human standing position, the inguinal region
is a zone supporting the abdominal thrust, and weakened by the orifice of
the inguinal and femoral passages. Peritoneal diverticulum may externalize

into these orifices, leading to the formation of hernias. [40] It is the
strengthening of this layer that is the main idea behind any hernia repair, be
it tissue repair in form of herniorrhaphy of repair using prosthetic material

like mesh called hemioplasty.
2) Inguinal nerves: The cutaneous nerves originating from these nerves studied
by Akita and Niga, and found that the cutaneous nerve originates from the

ilioinguinal nerve in 90.7%. In addition to that 35.2% also originates from
the genital branches of the genitofemoral nerve. In 13.0% the genital branch
and the ilioinguinal nerve united in the inguinal canal. In 11% cases the
genital branch pierced the inguinal ligament to enter the inguinal canal, and

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