الفهرس 
INTRODUCTION
OPERATIONSOnly 14 pages are availabe for public view
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Abstract
The latter part of the eighteenth century heralded dramatic changes as the anatomy of the groin became better understood. Until 40ies of the last century, the repair of inguinal hernia based mostly on external oblique, internal oblique and inguinal ligament. The role of transversus muscle and fascia in herniorrhaphy was hardly recognized. (1) Nowadays, it is recognized that suturing in these structures contribute minimally to the strength of inguinal herniorrhaphy, while it is well proved that transversus abdominis muscle and fascia play a major role in inguinal hernia repair. (2-4)
The anatomy of the groin is best understood when observing from the approach for the herniorrhaphy to be performed. For a conventional operation, this means from the skin to the deeper layers. For the laparoscopic operations or the preperitoneal operations, one should consider the anatomy from the abdominal cavity to the skin. In performing proper inguinal herniorrhaphy, some anatomical points should be clarified:
1. External oblique muscle and fascia (Fig.1)
The external oblique aponeurosis is functionally indifferent and presents no barrier to the formation or progress of inguinal hernia, since complete excision of this structure, as in radical groin dissection, does not result in hernia, if the transversus abdominis muscle and fascia are sutured to Cooper’s ligament. (4, 5)
2. Inguinal ligament (Fig.2,6)
The inguinal ligament is not the origin of the internal oblique, transversus and cremaster muscles, but they only have loose fascial attachment to it. (6) It was the first ligament employed in the inguinal hernia repair and it has retained a prominent position in hernia surgery for long time. But this concept was changed by the fact that it is not the insertion of the posterior inguinal wall, and any repair applied to it will be superficial to the defect in the Posterior wall. (4, 6)
3. Internal oblique muscle and fascia (Fig.3)
The internal oblique muscle has minor or no role in the development of inguinal hernia. Although it is commonly employed in the inguinal hernia repair, it is not basic structural unit and is not functional in inguinal hernia repair. (4, 5)
4. Cremasteric muscle and fascia
The muscle exhibits a pointed tendon of origin from the iliopsoas fascia, which pierces the lowest fleshy fibres of the internal oblique muscle. (4, 5)