The Groin Physiology Revisited

Abstract

The purpose is to contribute new information to the existing body of knowledge of the physiology of the groin. In a prospective ultrasonographic study, after an informed consent, 10 men and 10 women who were intact in the groin areas of surgery or relevant disease were involved. For a comparison, additional groups of 5 men and 5 women with abdominal wall hernias, but with no groin hernias, and other 5 men with inguinal hernias were included. The distal descent of the internal oblique muscle during the Valsalva’s manoeuvre in men was 0.8 cm ± 0.1 and in women it was 0.3 cm ± 0.1 (p < 0.001); the plate of transversus abdominis muscle changed its initial configurations and took on the characteristics of aponeurosis. During the Valsalva manoeuvre the rectus abdominis muscle demonstrated a distal latero-caudal shift of its lateral margin. In individuals with failed mechanics of the abdominal wall, the rectus abdominus does not realize the protective function. The mobile anatomic structures in the groin are oriented in three frontal planes. It formulated the concept of a synchronous protective function of all myofascial structures in the groin. We established that the anatomic structures transform the inguinal canal into a hermetic entity, which protects both the ingunal canal and the spermatic cord.

 

Share and Cite:

Kovachev, L. and Tonchev, P. (2014) The Groin Physiology Revisited. International Journal of Clinical Medicine, 5, 741-751. doi: 10.4236/ijcm.2014.513101.

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1] Stoppa, R. (2004) Historical Comment on Modern Work. Hernia, 8, 16-17.
http://dx.doi.org/10.1007/s10029-003-0171-8
[2] Brendan Devlin, H., Kingsnorth, A., O’Dwyer, P.J. and Bloor, K. (1998) Epidemiology and Aetiology of Primary Groin Hernias in Adults. In: Management of Abdominal Hernias, 2nd Edition, Chapman & Hall Medical, London, Chapter 3.
[3] Abrahamson, J. (1998) Etiology and Pathophysiology of Primary and Recurrent Groin Hernia Formation. Surgical Clinics of North America, 78, 953-972.
http://dx.doi.org/10.1016/S0039-6109(05)70364-9
[4] Skandalakis, J.E., et al. (1993) Embryologic and Anatomic Basis of Inguinal Herniorrhaphy. Surgical Clinics of North America, 73, 830.
[5] Geisler, D.P., Jegathesan, S., Parmley, M.C., et al. (2001) Laparoscopic Exploration for the Clinically Undetected Hernia in Infancy and Childhood. The American Journal of Surgery, 182, 693-696.
http://dx.doi.org/10.1016/S0002-9610(01)00797-8
[6] Van Wessem, K.J.P., Simons, M.P., Plaisier, P.W. and Lange, J.F. (2003) The Etiology of Indirect Inguinal Hernias: Congenital and/or Acquired? Hernia, 7, 76-79.
http://dx.doi.org/10.1007/s10029-002-0108-7
[7] Kukudjanov, N.I. (1969) Groin Hernias. Medicina, Moskow. (in Russian)
[8] Keith, A. (1924) On the Origin and Nature of Hernia. British Journal of Surgery, 11, 455-475.
http://dx.doi.org/10.1002/bjs.1800114307
[9] Ogilvie, H. (1959) Hernia. Edward Arnold, London.
[10] Lytle, W. (1945) The Internal Inguinal Ring. British Journal of Surgery, 32, 441-446.
http://dx.doi.org/10.1002/bjs.18003212802
[11] Nyhus, L.M., Klein, M.S. and Roger, F.B. (1991) Inguinal Hernia. Current Problems in Surgery, 28, 407-450.
http://dx.doi.org/10.1016/0011-3840(91)90028-N
[12] Zimmerman, L.M. (1971) Recurrent Inguinal Hernia. Surgical Clinics of North America, 51, 1317-1324.
[13] Donahue, P.E. (1989) Theoretic Aspects of Hernia. In: Nyhus, L.M. and Condon R.E., Eds., Hernia, 3rd Edition, J.B. Lipp Co., Philadelphia, 65-73.
[14] Hahn-Pedersen, J., Lund, L., Hønus, J.H. and Bojsen-Møller, F. (1994) Evaluation of Direct and Indirect Inguinal Hernia by CT. British Journal of Surgery, 81, 569-572.
http://dx.doi.org/10.1002/bjs.1800810430
[15] Young, J., Gilbert, A.I. and Graham, M.F. (2007) The Use of Ultrasound in the Diagnosis of Abdominal Wall Hernias. Hernia, 11, 347-351.
http://dx.doi.org/10.1007/s10029-007-0227-2
[16] Truong, S.N. and Jansen, M. (2002) Diagnostic Imaging in the Evaluation and Management of Abdominal Wall Hernia. In: Fitzgibbons, R.J. and Greenburg, A.G., Eds., Nyhus and Condon’s Hernia, 5th Edition, Lippincott Willliams and Wilkins, Philadelphia, 81-94.
[17] Bradley, M., Morgan, D., Pentlow, B. and Roe, A. (2003) The Groin Hernia—An Ultrasound Diagnosis? Annals of the Royal College of Surgeons of England, 85, 178-180.
http://dx.doi.org/10.1308/003588403321661334
[18] Kovachev, L. (1995) Ultrasonographic Characteristics of Different Methods of Inguinal Hernia Repair. Surgery Today, 25, 612-618.
[19] Kovachev, L. (1997) Groin Area—Structures and Function. In: Damianov, D., Ed., Hernias, Medart, Sofia, 7-27. (in Bulgarian)
[20] Kovachev, L. (2004) Groin Physiology. In: Kovachev, L., Ed., Groin Hernia, Eurasia Abagar, Pleven, 42-57. (in Bulgarian)
[21] Fruchaud, H. (1953) The Effect of the Upright Position Proper to Man upon the Anatomy of the Inguinal Region: Surgical Consequences; Anatomic Bases of Surgical Treatment of Inguinal Hernia. Mem Acad Chir (Paris), 63, 652-661. (in French)
[22] Rizk, N.N. (1989) Muscles of the Abdomen. In: Williams, P.L., Warwick, R., Dyson, M. and Bannister, L.H., Eds., Gray’s Anatomy, 37th Edition, C Livingstone, New York, 595-604.
[23] Prescher, A. (1999) Surgical Anatomy. In: Schumpelick, V. and Kingsnorth, A.N., Eds., Incisional Hernia, Springer, Berlin, Heidelberg, New York, 45-58.
[24] Peiper, C., Junge, K., Prescher, A., Stumpf, M. and Schumpelick, V. (2004) Abdominal Musculature and the Transversalis Fascia: An Anatomical Viewpoint. Hernia, 8, 376-380.
http://dx.doi.org/10.1007/s10029-004-0254-1
[25] Skandalakis, J.E., Gray, S.W., Skandalakis, L.J., Colborn, G.L. and Pemberton, L.B. (1989) Surgical Anatomy of the Inguinal Area. World Journal of Surgery, 13, 490-498.
http://dx.doi.org/10.1007/BF01658861
[26] Pierpont, R.Z., Grigoleit, A.W. and Finegan, M.D. (1969) The Transversalis Fascia: A Practical Analysis of an Enigma. The American Surgeon, 35, 737-740.
[27] Condon, R.E. (1978) The Anatomy of the Inguinal Region and Its Relationship to Groin Hernia. In: Hernia, L., Nyhus, M. and Condon, R.E., Eds., Hernia, 2nd Edition, J.B. Lipp Co., Philadelphia, 14-53.
[28] Kovachev, L. (1985) Anatomic Preconditions for Femoral Hernia Appearance and Its Surgical Treatment. Dissertation, Medical University of Pleven, Pleven.
[29] Abrahamson, J. (2001) Mechanisms of Hernia Formation. In: Bendavid, R., Abrahamson, J., Arregui, M.E., Flament, J.B. and Phillips, E.H., Eds., Abdominal Wall Hernias: Principles and Management, Springer-Verlag, New York, 133-137.
http://dx.doi.org/10.1007/978-1-4419-8574-3_16

Copyright © 2023 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.