PUTTING A FINGER ON THE DEEP INGUINAL RING

The clinical distinction between direct and indirect inguinal hernias is often made by determining whether digital pressure over the deep in guinal ring is able to control the hernia. In 25 consecutive patients having inguinal hernia operations, the positions of the mid-inguinal p oint and the mid-point of the inguinal ligament were determined pre-op eratively and compared with the position of the deep inguinal ring mea sured at operation. Neither the mid-inguinal point nor the mid-point o f the inguinal ligament correctly predicted the position of the deep i nguinal ring (the mean position of the deep inguinal ring was found to be 0.52 cm lateral to the mid-inguinal point and 0.46 cm medial to th e midpoint of the inguinal Ligament). If the position of the deep ingu inal ring cannot be accurately determined using fixed landmarks, it is unlikely that direct and indirect inguinal hernias can be distinguish ed by clinical examination.