In studying anatomical samples of both inguinal hernia patients and healthy
controls with no changes observable in the inguinal region, the authors ai
med at investigating the constitution of the inguinal region in relation to
the formation of inguinal hernia. The morphological investigation of 68 an
atomical samples and 44 inguinal regions at autopsy, revealed that the leng
th of the interspinal line, independent of sex, varies from 180 to 310 mm a
nd is 63 to 132 mm removed from the pubic tubercle (the height of the anter
ior pelvic arch). Thus, in 35% of male and 22% of female subjects the heigh
t of the anterior pelvic arch exceeded 75 mm indicating a low position of t
he groin. The research carried out in 640 inguinal hernia patients and 186
controls indicated a shift towards higher values in the interspinal line in
inguinal hernia patients as compared with the controls. In addition, the h
eight of the anterior pelvic arch in patients with inguinal hernia conspicu
ously exceeded that observed in the controls.
The present study undoubtedly shows that the number of muscle and connectiv
e structure variations of the inguinal region depends upon the position of
the groin in relation to the interspinal plane. The authors therefore agree
with the classification of these relationships to high, medial and Low gro
in position. The high position of the pubic tubercles up to 75 mm removed f
rom the interspinal spine is accompanied with the firm constitution of the
entire inguinal region. Moreover the Medial position of pubic tubercles 75
to 90 mm removed from the interspinal line does not indicate the risk of de
veloping inguinal hernia. On the other hand, the low position of the pubic
tubercles more than 90 mm removed from the interspinal line is often due to
the inferior constitution of the inguinal region. This group is regularly
at higher risk of developing inguinal hernia, particularly with other risk
factors being added as well.
The identification of structural characteristics of the inguinal region the
refore enables the selection of the most appropriate operation procedure, i
.e. between the classic hernia repair and endoscopic approach for prostheti
c mesh implantation.