ANATOMICAL LANDMARKS OF THE INGUINAL CANAL IN PREPUBESCENT CHILDREN

Background: Most adult anatomical texts state that the deep inguinal r ing is situated midway between the anterior superior iliac spine and t he pubic tubercle. The aim of this study was to determine if this was true in prepubescent children. Methods: A total of 107 inguinal ligame nts and canals were measured during inguinal operations in 80 children (68 boys, age range 1-118 months). Results: The length of the inguina l ligament increased from a median of 4.3 cm (range 3.6-6.8) at less t han 1 year of age to 7.5 cm (range 6.7-10.1) at over 4 years of age. T he internal ring was situated medial to the midpoint of the inguinal l igament throughout childhood. The ratio of internal ring to pubic tube rcle over inguinal ligament length was 42% (range 27-58) at less than 2 years; and 34% (range 25-46) at over 4 years. The inguinal canal rem ained short (median 1 cm (range 0.7-1.1) at less than 2 years, and med ian 1.1 cm (range 0.7-2.3) at over 4 years) suggesting that growth of the inguinal region in this age group occurs outside the canal. Conclu sions: These results have implications for the siting of incisions, an d question the necessity of opening the inguinal canal in children.