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Background: Inguinal endometriosis is one of the most common forms of endometriosis. The present study introduces 8 cases of inguinal endometriosis and discusses probable theories of inguinal endometriosis by reviewing the literature. Case presentation: 8 Iranian cases of inguinal endometriosis with a mean age of 36 years were presented. Catamenial groin pain and swelling were the most common complications. Also, patients usually had accompanying symptoms such as pelvic pain and dysmenorrhea. One-half of patients had a history of previous abdominal surgery. Ultrasound was diagnostic in 4 patients (50%), and magnetic resonance imaging was used in two patients (25%). Among 6 patients who underwent hormonal therapy, 4 experienced an endometriosis size increase. Inguinal endometriosis was right-sided in 87.5% of patients, and among 4 patients who underwent surgery, 75% had proximal site involvement of the round ligament. Conclusion: According to the rarity of inguinal endometriosis, it is more likely to be a misdiagnosis with other inguinal disorders such as inguinal hernia. Inguinal endometriosis should be considered in patients who undergo inguinal herniorrhaphy, with suspected findings such as thickening of the hernia sac wall, bloody fluid inside the sac, or thickening of the extraperitoneal round ligament during the surgery. [ABSTRACT FROM AUTHOR]

Introduction: Over the course of the past several years, several improvements have been made to the traditional Lichtenstein's hernioplasty approach to reduce the likelihood of post-operative complications and eliminate the possibility of chronic pain. Earlier, mesh fixation was used to be done by suture application. However recently, different non-traumatic alternative methods of mesh fixation like tissue compatible glues are being considered. Methods: The present randomized control study included a total of 60 patients, randomized equally (n=30 each) into two groups. Patients in group A were operated on for hernia repair using polypropylene 2-0 sutures for mesh fixation while in group B N-Butyl-2 cyanoacrylate glue was used for mesh fixation. Results: Mesh fixation time was significantly more in patients with propylene sutures than in glue (p=0.001). Total surgery time was also more for patients of propylene suture group with unilateral (73.38±10.75vs 65.42±21.31, p=<0.001) or bilateral (149±51.19vs 136±30.93, p=0.606) hernia, however in patients with bilateral hernia the difference was not statistically significant. Post-operative pain, analgesia requirement, time taken to return to normal activity, and postoperative complications like seroma, hematoma, and local numbness were not statistically significant. Conclusions: the use of a synthetic tissue adhesive N-butyl-2-cyanoacrylate glue is a feasible option for mesh fixation in patients with simple inguinal hernias undergoing Lichtenstein's hernioplasty, without adversely affecting the clinical outcomes. [ABSTRACT FROM AUTHOR]

Background The inguinal region is an area of complex anatomy that could contain diverse uncommon contents in routine clinical practice. Although inguinal hernia repair is one of the commonest surgeries done routinely, thorough preoperative imaging has a significant impact on the outcome of the surgery, by revealing the presence of unusual contents in the inguinal region. Aim The aim of this article is to review the differential diagnosis of the uncommon inguinal pathologies, which can simulate an inguinal hernia, to determine, and to simplify the treatment approach. Conclusions A profound understanding of the imaging characteristics of uncommon inguinal pathologies is crucial for both the radiologists (to prevent misdiagnosis) and the treating physicians (to avoid surgical complications) and ensure optimal management. [ABSTRACT FROM AUTHOR]

Our aim was to gain an idea about testicular injury by comparing the reduced volume, which is one of the indirect indicators of testicular damage in undescended testes, and by evaluating the reduced microvascular blood flow by superb microvascular imaging, and also to determine whether superb microvascular imaging modes could detect microvascular blood flow in more detail in the decreased volume of undescended testes. We compared testicular blood flow in undescended testes via conventional Doppler imaging, color superb microvascular imaging, and monochrome superb microvascular imaging techniques with contralateral normally located testis and normal control group. Each sample of testicular tissue was evaluated using a qualitative method. Spot color encoding and linear flow color encoding counts determined in testicular parenchyma were counted separately and expressed as numerical data. The localization of the examined testes in the grayscale was noted (proximal inguinal canal, medial inguinal canal, distal inguinal canal, and scrotal). The volume of undescended testes was calculated automatically via a formula for volume. Monochrome superb microvascular imaging is significantly superior in visualizing the vascularity of undescended testes compared with color Doppler, power Doppler and color superb microvascular imaging (p = 0.001). Also, undescended testes have a significantly lower blood flow compared with contralateral normal testes (p = 0.001). The volume of undescended testes was significantly lower than the contralateral normal testes. The volume, structure and blood flow are indirect signs of testicular damage in undescended testes. Monochrome superb microvascular imaging can detect vascularity in undescended testes better than the conventional Doppler imaging technique and color superb microvascular imaging. Based on our findings, we can report that monochrome superb microvascular imaging can be used to evaluate testicular injury and vascularity of undescended testes. [ABSTRACT FROM AUTHOR]

Background: In traditional laparoscopic orchiopexy for inguinal undescended testis (UDT) surgery, the testicles are pulled back into the abdominal cavity by grasping and cephalad retracting the testicle and the cord. If this fails, a subsequent open inguinal incision is made to complete orchiopexy. To improve the orchiolysis and avoid extra open inguinal incision, we describe our early experience with and illustrate the surgical procedure of a novel anatomical laparoscopic orchiopexy (ALO) and hybrid transscrotal orchiopexy as required in high palpable UDT. Methods: From March 2018 to April 2020, ALO was performed in 140 consecutive patients (158 testes) with high inguinal UDT. After blunt and bloodless dissection of the inter-tunica vaginalis-cremasteric fascia plane, tunica vaginalis enveloping the testis was brought into the abdominal cavity as a whole. When the tunica vaginalis was unable to be brought into the abdominal cavity, given that the orchiolysis had already been partially carried out, the testis could be brought out of the external ring and descended when converting to transscrotal surgery. Results: The mean age in this study was 1.88 years (standard deviation ±1.95). The position of the testis assessed at surgery was peeping (58, 36.7%) and canalicular (100, 63.3%). In 128 testes (81.1%), ALO brought the UDT into the abdominal cavity; the remaining 30 testes (18.9%) required a hybrid transscrotal technique. All testes were descended without conversion to open inguinal procedure. The mean operative time was 43.9 ± 9.2 minutes. All patients had follow-up within a median of 17.8 months, with satisfactory results in relation to viability and location of the testis. Conclusions: ALO was shown to be not only safe, feasible, and effective for high inguinal UDT but also facilitated subsequent hybrid transscrotal orchiopexy; when the testis failed to be pulled into the abdominal cavity, the conversion to open inguinal orchiopexy could be obviated. [ABSTRACT FROM AUTHOR]

In children and adolescents, inguinal and scrotal diseases are relatively common, and imaging is very useful for the diagnosis and differential diagnosis of these diseases. Therefore, it is important to understand the imaging findings of these diseases. In this article, we classify these diseases into small testes, cryptorchidism, patent processus vaginalis, acute scrotum pain, trauma, testicular tumors, and others and describe their characteristic findings. [ABSTRACT FROM AUTHOR]

Introduction: Inguinal hernia repair by open method is among the most frequently performed surgical procedures. The current standard surgical procedure employed is Lichtenstein's tensionfree mesh repair which requires covering an area defined by anatomic landmarks like Anterior Superior Iliac Spine (ASIS), pubic tubercle, conjoint tendon etc. with a mesh. The distances among these landmarks vary depending upon stature, race, and gender of the patients. Aim: To study whether the commercially available mesh size can be reduced specifically for a subset of Indian population by estimating the actual sizes of mesh applied during inguinal hernia surgery. Materials and Methods: In this prospective clinical study 25 patients undergoing open inguinal mesh hernioplasty were studied at a tertiary care centre over a period of one year from August 2019 to July 2020. During surgery the standard size commercially available mesh (15x7.5 cm2) was trimmed down according to the dimensions and anatomical landmarks that were assessed during surgery in the usual manner. Since it is difficult to measure size of applied mesh intraoperatively and because it is often irregular in shape, a novel method was adopted to estimate the mesh size applied. The trimmed out portions of the mesh were weighed using a high precision electronic weighing machine. The ratio of weight of trimmed out portion to total weight of the standard sized mesh was used to derive the area of the mesh applied. Statistical analysis and significance tests were performed using spreadsheet software and student's t-test, respectively. Results: Areas of mesh actually applied in the study-mean (85.26±11.04 cm2), mean+2SD (107.34 cm2), most common (75-97.4 cm2) and maximum (102.75 cm2)- all were found to be less than the standard, commercially available size of mesh. No statistically significant difference was found between areas of mesh applied in patients with indirect and direct hernias using unpaired student t-test (p-value=0.1076). Conclusion: Areas of mesh actually applied in present study were found to be less than the standard, commercially available size of mesh for inguinal hernia repair. [ABSTRACT FROM AUTHOR]

Although the correct diagnosis of inguinal hernias can often be made by clinical examination, there are several situations in which imaging methods represent the best option for evaluating such hernias, their content, and the possible complications. In addition, bulging of the inguinal region is not always indicative of a hernia, because other lesions, including tumors, cysts, and hematomas, also affect the region. The objective of this pictorial essay is to demonstrate what can be identified within inguinal hernias. Differentiating the types of herniated structures is of absolute importance for planning the appropriate treatment. [ABSTRACT FROM AUTHOR]

We describe a case of a 37-year-old man with painless left inguinal bulging due to a 5-cm solid mass adjacent to spermatic cord. Ultrasound-guided core needle biopsy was performed and histopathological examination revealed a mammary-type myofibroblastoma. Despite being rare, this is an emblematic case of a spermatic cord tumor which could be managed with marginal surgical excision, preserving spermatic cord, because of preoperative diagnosis. [ABSTRACT FROM AUTHOR]

Purpose: The inguinal canal anatomy is of paramount clinical significance due to the common occurrence of direct and indirect inguinal hernias. However, the inguinal canal is often an area of great difficulty for medical students to understand. The aim of this study was to evaluate the use of a low-cost, low-fidelity inguinal canal model as a teaching and learning aid. Methods: A low-fidelity inguinal canal model was introduced as a learning aid in an anatomy tutorial on the inguinal region. Students were randomised into intervention (n = 66) and control (n = 40) groups. Following the tutorial, all students completed a multiple-choice question quiz on the inguinal canal. The intervention group also completed a questionnaire evaluating the positive and negative aspects of the model. Results: Students taught with the inguinal canal model achieved higher scores (mean: 88.31% vs 81.7%, p = 0.087). Positive aspects of the model as described by the students included its simplicity and ability to improve their three-dimensional understanding of the inguinal canal. Students requested more hands-on time with the model during the tutorial. Conclusion: The present study supports current literature in that low-fidelity anatomy models are a useful adjunct to aid students' learning of complex anatomical concepts. Students may benefit from creating their own inguinal canal model to retain as a personal study tool. [ABSTRACT FROM AUTHOR]

Purpose: To compare the insertions of the conjoint tendon (CT) on MRI in athletes with and without symptoms and to assess their relationship to groin pain with surgery as a reference.Materials and Methods: Between January and May 2017, patients with inguinal-related groin pain undergoing Shouldice repair were prospectively enrolled and underwent MRI. Exams were independently reviewed by two radiologists blinded to surgical results to assess types of CT insertion as high muscular without (type 1) or with tendinous expansion (type 2) or low muscular (type 3). Radiological and surgical results were compared. Patients were compared with a gender- and age-matched control group of asymptomatic athletes.Results: One hundred twenty-eight walls (64 in patients, 64 in controls) in 64 subjects (32 patients and 32 controls, only men; mean age, 31.7 ± 10 years; range, 15.0-54.8) were analyzed. CT insertion was defined as types 1, 2, and 3 in 32/128 (25%), 35/128 (27%), and 61/128 (48%) walls, respectively, with 22/64 (34%), 27/64 (42%), and 15/64 (23%) in patients and 10/64 (16%), 8/64 (12.5%), and 46/64 (72%) in controls. Type s1+2 were significantly more frequent in patients compared with that in controls (p < 0.01). MRI predicted a high CT insertion with a sensitivity and specificity of 97% (95%CI 85-99) and 62% (95%CI 36-82). The intra- and inter-reader agreement for the prediction of the type of insertion was excellent (k > 0.75).Conclusion: A high CT insertion is more frequent in athletes with groin pain and may be a predisposing factor. MRI could help predict the type of CT insertion.Key Points: • MR imaging should be included in the initial workup of patients with inguinal-related groin pain. • MR imaging can be used to visualize the type of insertion with acceptable results. • High insertion of the conjoint tendon may be a predisposing factor for inguinal-related groin pain. [ABSTRACT FROM AUTHOR]

BACKGROUND AND OBJECTIVE: Hydatid disease is a common health problem in developing countries. The liver and lungs are the most common organs affected by this infection. Hydatid cyst is very rare in the inguinal area. The aim of this case report was to introduce a patient with multiple hydatid cysts in the right inguinal area who developed symptoms of inguinal hernia. CASE REPORT: The patient is a 92-year-old man who was referred to Imam Reza Hospital in Mashhad due to pain, swelling and redness in the right inguinal area. The patient's blood tests showed an increase in neutrophils, and a decrease in eosinophils, basophil and monocyte. Ultrasound examinations of the patient revealed right inguinal hernia and hydatid cysts in the liver, abdomen and pelvic cavity. Finally, the patient was operated with a diagnosis of incarcerated inguinal hernia. During the operation, multiple cysts were observed in the inguinal area; the cysts were removed and sent to pathology. Pathological findings confirmed the presence of hydatid cyst. After 2 days, the patient was discharged in relatively good general condition and with albendazole (400 mg) twice daily for 6 months. At the end of the treatment period, no signs of recurrence of hydatid cyst were observed in the patient. CONCLUSION: According to the cases reported in patients diagnosed with hydatid cyst with inguinal pain, the possibility of migration or hernia of hydatid cyst should be considered, because knowing its presence is useful for preoperative planning and reduction of complications. [ABSTRACT FROM AUTHOR]

Abdominal hernias are usually located in the inguinal canals. Differential diagnosis of hernias should consider other pathologies, which typically occur at this site. The aim of this review paper is to present fat-containing lesions located in the inguinal canal based on both our own experience and literature. The first part of the paper describes the embryogenesis and differences in the structure and content of male and female inguinal canal. The canal is clearly wider in men, which results from the presence of the spermatic cord and its components. The female canal contains only the narrow round ligament of the uterus. The second part of the paper discusses the incorrect use of the term "lipoma" for retroperitoneal fat, which penetrated into the lumen of the patent processus vaginalis -- the authors using this term acknowledge its incorrectness. These lesions often coexist with oblique inguinal hernia and should be excised during a surgery as they may cause inguinal pain. As for other fat-containing inguinal pathologies, we discussed lipomatosis of the spermatic cord, liposarcoma and the greater omentum. Differential diagnosis of these lesions considers their echogenicity, echostructure and vascularity. Furthermore, attention was paid to the adipose tissue surrounding the lower epigastric vessels, which may be incorrectly localized in the inguinal canal. Finally, the importance of proper diagnostic methodology and knowledge of the inguinal anatomy for the correct ultrasonographic diagnosis was emphasized. [ABSTRACT FROM AUTHOR]

Hernia is a protrusion of viscera through an acquired orifice, having as constituents the ring, contents and hernial sac. Scrotal hernias occur when, due to a defect in the inguinal ring, some viscera travel through it, reaching the scrotum. Its etiology is not completely elucidated, and the increase in intra-abdominal pressure is one of the probable triggers. In canines, this is a rare condition and the few reports mention it in young animals. The objective was to describe the occurrence of a left unilateral scrotal hernia with protrusion of the greater omentum in a 14-year-old Dachshund dog weighing 12.1 kg of body weight. To reduce the content of the abdominal cavity, it was necessary to make an incision in the cranial inguinal region, open the hernial sac and orchiectomy. The importance of surgical treatment of scrotal hernia is highlighted, as well as the inclusion of this condition in the differential diagnosis for testicular disorders of adult or elderly dogs. [ABSTRACT FROM AUTHOR]

Abstract The canal of Nuck is the female equivalent of the processus vaginalis in the male but is less well known than its male counterpart. It is a rare entity not commonly encountered by radiologists, particularly in the adult population. Knowledge of the embryology and anatomy of the canal of Nuck is essential for identification of the various pathologic conditions that may occur in this location. Moreover, radiologists should be familiar with this entity to compose an appropriate and thorough differential diagnosis of a labial mass/swelling. In this review, we discuss both the anatomy and the more common pathology that can be encountered within it. Highlights • The canal of Nuck is the female equivalent to a patent processus vaginalis in the male. • The term canal of Nuck as well as the anatomy of it is not well known by radiologist or surgeons. • There are a variety of normal structures and possible pathologic findings that can be found in this anatomic region. • Understanding the anatomy and embryology of the canal of Nuck is essential for interpretation of the radiologic findings. [ABSTRACT FROM AUTHOR]

Emergencies involving the inguinal region and scrotum are common and can be caused by a plethora of different causes. In most cases, such conditions have nonspecific symptoms and are quite painful. Some inguinoscrotal conditions have high complication rates. Early and accurate diagnosis is therefore imperative. Ultrasound is the method of choice for the initial evaluation of this vast range of conditions, because it is a rapid, ionizing radiation-free, low-cost method. Despite the practicality and accuracy of the method, which make it ideal for use in emergency care, the examiner should be experienced and should be familiarized with the ultrasound findings of the most common inguinoscrotal diseases. On the basis of that knowledge, the examiner should also be able to make an accurate, direct, precise report, helping the emergency room physician make decisions regarding the proper (clinical or surgical) management of each case. Here, we review most of the inguinoscrotal conditions, focusing on the imaging findings and discussing the critical points for the appropriate characterization of each condition. [ABSTRACT FROM AUTHOR]

Introduction: Merkel cell carcinomas (MCC) is an aggressive neuroendocrine carcinoma originating from the Merkel cell in the dermo-epidermal junction. Only 10% of MCC occur on the skin of the trunk. Case report: We report a case of Merkel's abdominal carcinomas treated with extensive inguinal lymphadenectomy and reconstruction of the abdominal wall and inguinal canal using prosthesis GORE® BIO-A®. Discussion: Immunohistochemical analysis by tumor-specific markers is crucial for diagnosis and permits differentiation from other tumors of the skin. MCC is an aggressive tumor with poor prognosis. Conclusions: For primary tumors without indications of the presence of organ metastases complete surgical excision is the gold standard. Gore BIO-A is a biosynthetic prosthesis with manageable structure that allows it to be positioned and shaped according to needs, its strength provides for excellent support for the reconstruction of the inguinal canal wall. [ABSTRACT FROM AUTHOR]

Introduction: Access to surgery in Africa is significantly limited. Treatment outcomes in Africa differ significantly compared to those achieved in Europe or the US. Therefore, to popularise tension-free repair, it is essential to determine the economically justified mesh size for the African population. Aim: To conduct anthropometric evaluation of the inguinal canal in African and European patients to determine its potential consequences for the mesh size for open and laparoscopic hernia repair. Material and methods: The measurements were made in 44 adult males in Africa (group I) and were compared to measurements in 45 consecutive Caucasian males (group II). The mean age of patients was respectively 48.3 and 51.2 years. Results: There was no statistically significant difference in the internal ring diameter between groups (2.2 vs. 2.1 cm; p = 0.58). The distance between the pubic tubercle and the inferomedial border of the internal inguinal ring was significantly shorter in group I (3.8 vs. 5.1 cm; p < 0.001). A similar difference was found in the length of transverse arch aponeurosis (2.9 vs. 4.0 cm; p < 0.001). The distance between the pubic tubercle and anterior superior iliac spine in group I was approximately 2 cm shorter on each side (10.0 vs. 11.8 cm; p < 0.001). Conclusions: The anatomical differences in inguinal dimensions between Central African and European populations support the potential need to adjust the standard size of synthetic mesh used for hernia repair to the needs of local populations. The significantly smaller dimensions of the inguinal canal in African males may allow the use of smaller meshes. [ABSTRACT FROM AUTHOR]

Bulging of the inguinal region is a frequent complaint in the pediatric population and sonographic findings can be challenging for radiologists. In this review we update the sonographic findings of the most common disorders that affect the inguinal canal in neonates and children, with a focus on the processus vaginalis abnormalities such as congenital hydroceles, indirect inguinal hernias and cryptorchidism, illustrated with cases collected at a quaternary hospital during a 7-year period. We emphasize the importance of correctly classifying different types of congenital hydrocele and inguinal hernia to allow for early surgical intervention when necessary. We have systematically organized and illustrated all types of congenital hydrocele and inguinal hernias based on embryological, anatomical and pathophysiological findings to assist readers in the diagnosis of even complex cases of inguinal canal ultrasound evaluation in neonates and children. We also present rare diagnoses such as the abdominoscrotal hydrocele and the herniation of uterus and ovaries into the canal of Nuck. [ABSTRACT FROM AUTHOR]

Abnormalities in the inguinal region are varied. The most common abnormality in the inguinal region is the hernia: direct or indirect inguinal hernia and femoral hernia. There are many hernia-mimicking lesions, such as spermatic cord hydrocele, undescended testis, hematoma, inflammation, abscess, benign or malignant tumors, metastatic or benign lymph node enlargement, round ligament varicosities or mesothelial cyst, and herniated ovary. Ultrasonography is currently the primary imaging modality used in assessing inguinal lesions and helpful for the differential diagnosis of a broad spectrum of these diseases. Familiarity with clinical setting and certain ultrasonography details will facilitate prompt and accurate diagnosis and treatment. [ABSTRACT FROM AUTHOR]

The presence of vermiform appendix in an inguinal hernia sac is known as Amyand's hernia. Amyand's hernia complicated with acute appendicitis is an extremely rare entity with challenging diagnosis and large debate about the optimal treatment option. We report a case of a 58-year-old man presenting to the Emergency Department with an incarcerated right inguinal hernia. At laparoscopy, an inflamed appendix was identified within the inguinal canal, representing an indirect Amyand's hernia. A laparoscopic appendicectomy was performed followed by a trans-abdominal pre-peritoneal mesh repair of the aforementioned hernia. We report this rare clinical entity raising physicians' awareness to include acute appendicitis within an Amyand's hernia in the differential diagnosis of incarcerated inguinal hernias, along with a successful minimally invasive surgical approach. [ABSTRACT FROM AUTHOR]

Key Clinical Message : The scrotum hematoma following femoral artery puncture is a rare complication. The bleeding from the puncture site drained through the inguinal canal into the scrotum. The present case may indicate the importance of quick observation of the scrotum, when the puncture of femoral artery was performed. The scrotum hematoma following femoral artery puncture is a rare complication. The bleeding from the puncture site drained through the inguinal canal into the scrotum. The present case may indicate the importance of quick observation of the scrotum, when the puncture of femoral artery was performed. [ABSTRACT FROM AUTHOR]

Objective: Lipomas or lipomatous structures in the spermatic cord or round ligament are often encountered during the inguinal canal exploration for laparoscopic or open inguinal hernia repairs. As the primary aim of the operation is the hernia repair, approach to these structures is controversial. In this study the incidence of spermatic cord and round ligament lipomas were demonstrated, and their association with hernia type and BMI (Body mass index) were discussed in the light of the literature. Material and Methods: in this retrospective study, 63 cases of spermatic cord and round ligament lipomas had been evaluated out of 327 open hernia repair operations, performed by a single general surgeon between April 2009 and 2014. Results: Of the patients 308 had unilateral hernia, with 286 males (92.9%) and 22 females (7.1%), whereas nineteen (6.2%) had bilateral inguinal hernia. The mean age of the 63 patients with lipomas was 43.6 (25-72), whereas that of the patients without lipomas was 41.2 (15-83). The pathological results of all the lipomatous structures were benign. BMI of the patients with and without lipomas were correspondingly 26.7 and 25.8., and the difference was not statistically significant, (p>0.05). The incidence of lipoma was significantly increasing in the patients with wide hernia pouch and wide internal inguinal ring (Nyhus Type 2, 3A ve 3B), (p<0.05). Conclusion: Inguinal canal lipomas observed during the inguinal hernia repairs are usually benign, and their excision should be made due to the risk of malignant transformation, recurrence prophylaxis and/or the mass effect. The painstaking care must be taken not to traumatize the ductus deferens, testicular artery and veins during the lipoma excisions for males. [ABSTRACT FROM AUTHOR]

Objective: Round ligament varicosity is a condition which can be seen in patients who applied with the complaint of inguinal pain and/or inguinal mass during pregnancy and can be clinically confused with inguinal hernia in particular. Since its differentiation from other inguinal masses which may require surgical intervention is important, we present the diagnostic information and postpartum follow-up ultrasonographic findings of the case. Case: We found venous vascular pattern after performing B-mode superficial ultrasonography and Doppler ultrasonography on the pregnant case, who applied with the complaint of painful inguinal mass and referred to our clinic with the pre-diagnosis of inguinal hernia, and we established the diagnosis of round ligament varicosity. Then, conservative approach was adapted and the pregnancy was completed without any problem. The varicosities regressed spontaneously after the delivery and disappeared completely. Conclusion: It is possible to establish the diagnosis of round ligament varicosity radiologically, and it is recommended to perform ultrasonography and Doppler ultrasonography in pregnant cases who apply with the complaint of inguinal mass. [ABSTRACT FROM AUTHOR]

Résumé Le diagnostic de pubalgie du sportif est difficile et impose d’avoir d’abord éliminé une pathologie uro-génitale ou digestive. Des déséquilibres entre les muscles obliques de l’abdomen et adducteurs, ou entre adducteurs et abducteurs de hanche, semblent au cœur de sa physiopathologie, mais celle-ci reste encore discutée. L’examen programmé du pubis permet d’évaluer la douleur, les amplitudes des hanches, la mobilité du rachis, et de mesurer la force des muscles en particulier celle des adducteurs et abdominaux (grands droits et obliques). La présence d’une hernie inguinale incite à une solution chirurgicale. Les douleurs isolées du canal inguinal doivent être soigneusement distinguées d’autres douleurs musculo-tendino-osseuses souvent intriquées, grâce surtout à la clinique, même si l’IRM paraît incontournable chez le sportif de haut niveau. Le traitement dépend des déficiences musculaires et articulaires. Il consiste en exercices de gain d’amplitude articulaire de hanche et/ou de renforcements musculaires analytiques, visant à redonner une dynamique au pubis et à permettre la reprise d’efforts infra-douloureux. La progression doit se faire étape par étape sans focaliser sur la durée d’indisponibilité sportive afin d’éviter les récidives, ou le passage à la chronicité. Si le traitement est bien conduit, la reprise du sport au même niveau est possible dans un délai de 3 mois dans 80 % des cas. Dans les formes rebelles, une indication chirurgicale de réparation des murs du canal inguinal peut être posée, qui donne de bons résultats dans 65 à 95 % des cas. Une prévention secondaire est nécessaire pour préserver les équilibres musculaires du pubis. Groin pain in sportsmen corresponds to a difficult clinical diagnosis which imposes first of all to eliminate uro-genital or digestive diseases. Physiopathology remains badly known even if the role of muscular imbalances between the rectus/obliquus abdominis and/or hip adductors/abductors is favored. The scheduled examination of the pubis allows to evaluate pain, the hips and back range of motion, and to measure the muscular force in particular of hip adductors and abdominal muscles (rectus and obliquus abdominis). If inguinal hernia may lead to surgical procedure, isolated pain of the inguinal canal must be carefully distinguished from other muscular-tendinosis-bone's pains. Clinical examination allows the diagnosis, even if MRI is a key imaging in the high-level sportsman. Treatment is based on the muscular and joint deficiencies analysis. It consists of hip range of motion gain and/or analytical muscular strengthening to restore the dynamics of the pubic joint and to allow the resumption of infra-painful sport training. Progress has to be made step by step. Indeed sport should not be resumed to early since recurrence of pain or even chronicity of pain would occurr. According to well-managed treatment, sport resumption at the same level is possible within 3 months in 80% of cases. When rehabilitation fails, a surgical indication to repair the different walls of the inguinal canal can be suggested with good results in 65 to 95% of cases. Secondary prevention must be set up to keep muscular balances of the pubis. [ABSTRACT FROM AUTHOR]

Introduction: Presence of the ovary, fallopian tube and uterus within an inguinal canal is a rare condition in women of reproductive age. Case report: In this report we present a 31-year-old female with 5 years primary infertility who was admitted for infertility evaluation. We described a patient with unicornuate uterus without rudimentary horn and the left fallopian tube within the left inguinal canal diagnosed through laparoscopy. Conclusion: The surgeon who works on infertility may encounter such unexpected intraoperative findings, and must call attention to these findings. [ABSTRACT FROM AUTHOR]

We report the case of a female adolescent who had an ectopic ovary in the inguinal canal without an associated hernia, a unicornuate uterus, and ipsilateral renal agenesis. The incidental discovery of the ectopic ovary and other Mullerian anomalies, as well as the surgical correction that followed, highlights important fertility considerations in children and available treatment algorithms for these rare cases. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study is to describe the ultrasonographic findings of ovarycontaining hernias of the canal of Nuck. Methods: This was a retrospective analysis of 22 hernia cases of the canal of Nuck. The following gray scale and color Doppler ultrasonographic features were analyzed: the site and the size of the hernia, the texture of the hernia contents, and the presence or absence of blood flow in the hernia contents. Results: All of the patients had swelling of the right inguinal region (n=10), left inguinal region (n=8), or both (n=2). On ultrasonography, the hernias appeared as either solid masses (n=17) or solid masses containing cysts (n=5). The mean anteroposterior diameter of the hernia sac of the canal of Nuck was 9.1 mm (range, 5 to 18 mm). The mean anteroposterior diameters of the hernia sac were 11.6 mm (range, 7.6 to 18 mm) for hernias containing an ovary, and 8.3 mm (range, 5 to 13 mm) for hernias containing omental fat. During surgery, among the 17 cases with solid-appearing hernia contents on ultrasonography, omental fat was identified in the hernia sac in four cases, but no structure was identified in 13 cases. All five cases that appeared as solid masses containing cysts on ultrasonography contained ovary tissue in the hernia sac. Among the four cases of ovary-containing hernias, color Doppler ultrasonography identified blood flow within the ovary in three cases, but no flow signal was seen in one case of incarcerated hernia. Conclusion: Ultrasonography may be helpful for the diagnosis of ovary-containing hernias of the canal of Nuck by detecting solid masses containing small cysts. [ABSTRACT FROM AUTHOR]

Normally testis is developed in the abdomen and descends in to the designated scrotal sac at the time of birth or within one or two years after birth. Several factors are associated with proper descent of the testis. Failure to descend, may lead to undescended testis or cryptorchidism. In the present case, we found an undescended testis partly in the inguinal canal and partly in the abdomen in a 71-year-old male cadaver. The epididymis descended first and its major portion was outside the superficial inguinal ring. The rest of the flattened epididymis was found inside the canal attached to the upper tapered pole of the testis and the vas deferens was found arising from this portion. The testicular vessels traversing through the deep inguinal ring then entered the postero-lateral portion of the tapered portion of the testis within the canal. No torsion and necrotic changes were observed in the undescended testis. Histological examination revealed a normal pattern in the epididymis which was outside the canal and a primitive duct system in the part of the epididymis within the canal. However, the entire testis showed only non-canalized smaller seminiferous tubules with very few cellular components and large inter-tubular spaces. The most common problems associated with such undescended testes are altered fertility, testicular cancer, inguinal hernia and testicular torsion with necrosis. Therefore, identifying the condition, evaluating the associated syndromes, proper diagnosis and therapeutic strategies are very important to prevent the adverse consequences mentioned above. [ABSTRACT FROM AUTHOR]

Epidermoid cysts can occur in a variety of locations including the face, trunk, neck, extremities, and scalp. No case of epidermoid cyst as content of inguinal hernia has been reported so far; however, cases with dermoid, teratoma, lipoma, lymphangioma and leiomyoma as content of inguinal canal have been reported. A 29-year-old female presented with a lump in the left inguinal region that was clinically diagnosed as left inguinal hernia. The patient was planned for laparoscopic inguinal hernia repair after routine investigation. Intraoperatively, a cystic mass was found to be attached to the left round ligament that was excised completely. Histopathological report was consistent with epidermal inclusion cyst. Inguinal epidermoid cyst mimicking inguinal hernia is a rare entity. If such a cyst is encountered during operation, it should be completely excised. [ABSTRACT FROM AUTHOR]

Appendicitis is the most common cause of acute abdomen in children; approximately one third of all cases present with appendiceal perforation at the time of surgery. Some of postoperative complications in this condition are abscesses. In unusual places such as the scrotum however, for an intraabdominal event to cause a scrotal abscess, fluid displacement requires the presence of a patent processus vaginalis. We report the case of a child with perforated appendix followed by a scrotum abscess owing to a permeable vaginal canal. The abscess was and the patient wes and treatment was performed based triple scheme antibiotics, evolving satisfactorily. [ABSTRACT FROM AUTHOR]

A 12-year-old donkey and a 6-year-old Connemara pony, both sexually intact males, were admitted for surgical removal of urinary calculi. Both underwent a laparoscopic-assisted cystotomy technique to exteriorise the bladder and remove uroliths via the inguinal canal after hemi-castration. Both surgeries were successful and no complications occurred. This modified technique, which is minimally invasive, may be a safe and efficient way to remove bladder stones from adult stallions. [ABSTRACT FROM AUTHOR]

Résumé: La pubalgie est une pathologie fréquente chez le sportif mais sa prise en charge reste pourtant un challenge. Sur le plan international, les terminologies s’harmonisent peu à peu et une volonté de créer des examens cliniques sensibles, spécifiques et reproductibles ainsi que des moyens de suivi thérapeutique validés émerge et devrait permettre la publication de travaux de plus haut niveau de preuve dans un proche avenir. Cette région anatomique est complexe et la physiopathologie reste discutée. Le diagnostic de pubalgie est un diagnostic d’élimination qui est posé suite à une démarche diagnostique rigoureuse. Quatre grandes entités anatomiques sont regroupées sous le terme de pubalgie. Cette dernière, dans de nombreux cas, présente une forme associée et le clinicien s’attache à proposer une cartographie précise des sites lésionnels. Il guide ainsi la prise en charge de rééducation qui est le plus souvent le traitement de première intention. Enfin par un suivi régulier, il évalue l’évolution des symptômes et opte si nécessaire pour un traitement chirurgical en cas d’échec ou de lésions ne répondant que partiellement au traitement conservateur. Une prise en charge multidisciplinaire centrée sur l’athlète permet un retour aux activités physiques sans douleur après plusieurs mois. [ABSTRACT FROM AUTHOR]

Background: According to increasing use of ultrasound in the diagnosis of inguinal herniation, this study was designed to evaluate the cross-sectional area of the inguinal canal in patients with inguinal herniation and its increase with Valsalva maneuver. We also compared the obtained values with those of normal population. Methods: a cross-sectional study, 52 normal persons and 35 cases with inguinal hernia were assessed. The cross-sectional area of the inguinal canal was measured in all subjects and data was analyzed using Student's t-test and Pearson's correlation tests in SPSS. Receiver operator characteristic (ROC) curves were traced to define cut-off points. Findings: Valsalva maneuver caused significantly greater increase in the cross-sectional area of the inguinal canal among patients than in the normal group. The cut-off point of the cross-sectional area of inguinal canal was 63.5 mm2 in neutral state and 72.5 mm2 with Valsalva maneuver (increase rate: 34 mm2). In the absence of Valsalva maneuver, a cross-sectional area of the inguinal canal of greater than 63.5 mm2 is predictive of inguinal hernia (with 91% sensitivity and 98% specificity). Otherwise, values greater than 72.5 mm2 will be predictive of inguinal hernia (with 100% sensitivity and 98% specificity). Inguinal hernia will also be suspected if Valsalva maneuver increases the cross-sectional area of the inguinal canal by more than 34 mm2 (with 91% sensitivity and 100% specificity). Conclusion: The following diagnostic criteria are suggested for diagnosis of inguinal hernia through ultrasound examination: the presence of bowel loop within the inguinal canal, a cross-sectional area of the inguinal canal > 63.5 mm2 without Valsalva maneuver and > 72.5 mm2 with Valsalva maneuver, an increase of > 34 mm2 in the cross-sectional area of the inguinal canal with Valsalva maneuver, and a > 0.5 cm movement of the spermatic cord with Valsalva maneuver. [ABSTRACT FROM AUTHOR]

Undescended testes or cryptorchidism in the most common congenital anomaly of male reproductive system. The descent is multifactorial with gubernaculums playing major role. The failure of descent can be at trans-abdominal or inguino-scrotal phase. Locating undescended testes is important in view of low fertility and high rate of occurrence of neoplasm in them. Ultrasound is the standard imaging technique of choice in children with a non-palpable testis as it is non-invasive and does not use ionizing radiation. Position of testis is also important in deciding whether patient will need abdominal or inguinal exploration. The aim was to study the position of undescended testes by high frequency ultrasound and its embryonic explanation. Total 41 boys with undescended testes underwent high frequency ultrasound. The location of testis was noted followed by its size and echotexture. Thirty patients had unilateral and 11 had bilateral undescended testes. The prevalence was more on right side (16 out of 30). Out of total 52, 46 (88%) testis were located by ultrasound. Six (12%) testes could not be located. Five (10%) were retractile testes. Out of remaining 41, 26 (63%) were located in inguinal canal and 15 (37%) were located in abdomen. Out of 15 abdominal testes 9 were located just proximal to inguinal canal and 6 were located in deep pelvis. High frequency ultrasound was able to locate the position of undescended testes in majority (88%) of the cases. [ABSTRACT FROM AUTHOR]

Angiomyofibroblastoma-like tumor is a rare mesenchymal tumor of men. It commonly occurs during the fifth to eighth decades of life and mainly involves the inguinoscrotal region. It is derived from perivascular stem cells and has capacity of lipoid and myofibroblastic differentiation. Histopathologically this tumor in the male genitalia mimics female angiomyofibroblastoma but there are morphological and immunohistochemical differences between these lesions. We report a case of an angiomyofibroblastoma-like tumor that arose in the scrotal region in a 40-year-old man. [ABSTRACT FROM AUTHOR]

Background Abdominal wall is the site of opposing physical forces thatmay eventually result in the appearance of the hernias. The external abdominal hernias are the most common forms, the inguinal hernia being the commonly encountered type [75% of the abdominal hernia]. Many factors are responsible for the formation of the inguinal hernia but, what makes a few people more susceptible to this situation is still clearly not proved. Few of the previous studies have concluded that the low lying pubic tubercle is associated with the development of the inguinal hernia. Objectives This study was designed to investigate the distance between the anterior superior iliac spines and the perpendicular distance of the pubic tubercle from the interspinal line. Methods 50 males with inguinal hernia compared with the control group comprising of 60 adult healthy males. Results This study revealed that both parameters (interspinal SS distance and the pubic tubercle height ST) in the study group were significantly greater than that in the control group. The distance from mid inguinal point to the superficial inguinal ring was also measured in both the study and control groups and the results show that the distance is shorter in the individuals with the inguinal hernia. Identification of the structural characteristics of inguinal region enables the surgeon to perform the surgical technique appropriately. Conclusion The low pubic tubercle group of cases has more tendencies for herniation. The unusual origin of internal oblique muscle in group II with low lying tubercle is far away, from the external half of the inguinal ligament, leaving the internal ring unprotected during abdominal muscle contraction, which is another causation of hernia development. [ABSTRACT FROM AUTHOR]

Liposarcoma is one of the most common soft tissue sarcomas. About 20% of liposarcomas originate in the retroperitoneum. It manifests as painless, slowly enlarg ing soft tissue mass. Inguinal region is one of the uncom mon locations for liposarcoma, the tumor arising from the spermatic cord. In this location, liposarcoma needs to be differentiated from other more common patholo gies in the canal including hernia. Very rarely retroperi toneal liposarcoma may manifest as inguinal hernia. We describe a case of a 60-year-old man who presented with left inguinoscrotal mass that was demonstrated to be solid enhancing soft tissue attenuation mass with small areas of fat inside on multidetector-row computed tomography (MDCT). Coronal reformatted CT revealed dumbbell shape of the mass with larger retroperitoneal component contiguous with smaller left paratesticular component across a narrow segment in the inguinal canal. Patient was operated and a large retroperitoneal mass was removed. Histopathology of the resected mass revealed a dedifferentiated liposarcoma. Thus, firm, non-tender and large irreducible inguinoscrotal swelling in an adult should be evaluated by CT to rule out a rare inguinal extension of retroperitoneal liposarcoma. MDCT, besides revealing the diagnosis can determine the true intra-abdominal (retroperitoneal) extent of such a dumb bell shaped tumor when only tip of iceberg is visible in the inguinal region. [ABSTRACT FROM AUTHOR]

Many atypical locations for deep endometriosis exist that are not well known to both the radiologist and gynecologist. This work explores these unusual localizations, which we have arbitrarily grouped under the term 'anterior endometriosis' in contrast to the more common posterior presentation of deep endometriosis that has been so well described in the literature. Parietal and inguinal involvement is first detailed, followed by a description of deep endometriosis involving the urinary system and anterior supporting ligaments of the uterus. A necessary adaptation to the MRI protocol in order to accurately diagnosis deep anterior endometriosis as well as specific diagnostic criteria for each type of lesion is reviewed. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to describe the MR imaging findings of Nuck canal endometriosis (NCE). Materials and methods: In a 10-year period, 486 out of 612 patients, with laparoscopically and/or surgically proven diagnosis of pelvic endometriosis, underwent MR imaging examination. The examinations were reviewed by two urogenital experienced radiologists working in consensus. Data analysis included: lesions location, size, morphological and signal intensity pattern, involvement of the adjacent muscles, and tendons. Results: In 372 out of 486 patients an MRI diagnosis of endometriosis was made. NCE was found in eight patients. All the lesions were located on the right side. The mean size of the lesions was 2.5 cm (range 1.5-4.5 cm). Two patterns of NCE were found: type 1, prevalently cystic ( n = 2); and type 2, prevalently solid with small scattered cysts within lesion ( n = 6). In all the patients, hemorrhagic hyperintense cysts could be seen on T1-weighted images. In four patients, the lesions involved the inguinal canal, and in another four patients, the lesions were only outside the inguinal canal. Involvement of the abdominis rectus muscle was seen in two patients, and of the adductor common tendon in two patients. Conclusion: MR imaging permits the diagnosis of NCE as well as the evaluation of exact extension of the disease. [ABSTRACT FROM AUTHOR]

Pediatric cases of Spigelian hernias are rare. Only a few reports on this condition, in combination with ipsilateral cryptorchidism and testis in the hernia sac, have been published. We report on Spigelian hernia in a 3-week-old boy containing both the ipsilateral testis, without a gubernaculum and an incarcerated loop of the small intestine. It has been suggested that the combination of Spigelian hernia and ipsilateral cryptorchidism is part of a new syndrome. We discuss whether the lack of a gubernaculum and an inguinal canal reported in other similar cases may be additional elements of this new syndrome. We present a comprehensive overview of pediatric patients with Spigelian-cryptorchidism syndrome reported in the English language literature. In 75% of male infants with Spigelian hernia, there is an associated ipsilateral cryptorchidism, and in 87% of these patients, the testis is found inside the hernia sac. Thus, the surgeon dealing with a congenital Spigelian hernia should look for an undescended testis and be prepared to find it in the hernia sac. [ABSTRACT FROM AUTHOR]

Peritoneal hydatidosis secondary to liver hydatid disease is not uncommon but peritoneal hydatidosis herniating to the inguinal canal is rare, with fewer than five cases reported in the literature. We describe a 54-year-old man who presented with a progressively enlarging soft, cystic swelling in the right inguinal region. Clinical examination suggestive of irreducible right inguinal hernia and ultrasonography revealed it to be a cystic swelling within the hernial sac. The swelling was excised en bloc and open mesh hernioplasty was performed. Cyst biopsy revealed hydatid disease; hence, the patient was put on adjunctive albendazole chemotherapy for 3 months. [ABSTRACT FROM AUTHOR]

Background: Many different techniques have been described to treat undescended testes. We aimed to study a new technique of two-stage orchiopexy with total inguinal canal mobilization to prevent cord damage and testicular atrophy. Methods: Between March 2002 and July 2005, we operated on 16 testes with short spermatic cord. In the first stage, the testes were anchored to the pubic tubercle and 6 months later (second stage) they were fixed in the scrotum through total inguinal canal mobilization. The patients were followed up by pre and postoperative physical examination, sonography of scrotum, and serum testosterone level measurement for 6-12 months. Results: Two of the 16 testes developed atrophy but 14 had volume increase. Mean testicular volumes of preoperative and 1 and 6 months postoperative testes were 0.69 ± 0.22 ml, 0.84 ±0.26 ml, and 1.06 ±0.33 ml respectively. The volume increase was not only significant 1 (P=0.012) and 6 (P=0.002) months after the second operation compared with the first operation but also a significant increase in the volume was noted between the 1st and 6th month after the operation (P=0.003). All testes were in scrotum after 6- 12 months and the patients had normal serum testosterone level for their ages before and after the operation. Conclusion: Two-stage orchiopexy with total inguinal canal mobilization prevents vascular damage in the second stage of operation. [ABSTRACT FROM AUTHOR]

Hernia of canal of Nuck is an extension of peritoneal fold through the inguinal canal up to the labia majora. Defective obliteration of this peritoneal fold leads to herniation of abdominal content into the inguinal canal. Incidence of ovary and fallopian tube as contents of henia is rare overall and very rare in middle age women. This hernia would require surgical intervention once diagnosed, but type of intervention may vary. Although mesh repair is acceptable worldwide with low recurrence rate, nonmesh repair still has a place specifically in developing countries wherein cost consideration without significantly affecting outcome will be an important factor. Two cases treated with nonmesh repair are reported. [ABSTRACT FROM AUTHOR]

Although 18F-fluorodeoxyglucose (FDG) is the most extensively used tracer in oncological positron emission tomography/computed tomography (PET/CT) studies, various physiological as well as benign pathological conditions are known to cause false-positive results. This report describes 18F-FDG PET/CT done in an elderly man with primary hepatocellular carcinoma, revealing a metastasis mimicking lesion in the left inguinal canal, which was identified as the herniated portion of the urinary bladder. Though rare, bladder herniation, especially with a narrow neck, can be a pitfall in the evaluation for metastatic disease. The study also highlights the utility of delayed imaging in the evaluation of pelvic pathology. [ABSTRACT FROM AUTHOR]

In the repair of inguinal hernia, the primary objective is to stop the recurrence of hernia, but it seems this expectation has not been met even with the Lichtenstein mesh repair. Therefore, a totally recurrence-free result cannot be reached until a rational technique is developed. In the new approach, the repair of the inguinal hernia was carried out routinely by a combination of a tension-free mesh implantation along with the on-lay nylon darn. The outcome of this new approach in 125 consecutive patients was found to be very satisfactory, with no evidence of recurrent inguinal hernia apart from a superficial wound infection developed in one patient and both wound infection and wound haematoma in another patient. A recurrence-free inguinal hernia is not a myth in this combined approach, which provides a complementary benefit to each other and a total satisfaction to the patient. It is also cost-effective in the long run. [ABSTRACT FROM AUTHOR]

The aim of this paper was to assess if there is a standard technique for the repair of inguinal herniae in children and to establish if the inguinal canal should be routinely opened during this procedure in different age groups. A postal survey was conducted by sending questionnaires to 264 consultant surgeons who were surgical tutors or advisors to the Royal College of Surgeons of England. Information was sought using a multiple-choice tick-box questionnaire. The surgical techniques of surgeons working in specialist units were compared with those working in general units, and comparisons were also drawn between surgeons performing more operations than those doing only a few and also if the technique varied with the age of the patient. The response rate was 69%. Only 23% working in specialist units and 8% from general units performed more than 30 herniotomies per year. Overall, 15% of surgeons always performed the operation through the inguinal canal, 56% performed it superficial to the external ring, and 29% tended to do both. In children under the age of 2 years, most surgeons performed the operation superficial to the external ring, although a higher proportion of surgeons at specialist units opened the inguinal canal routinely. In the older age groups, the tendency to open the inguinal canal and/or divide the external ring was greater. However, surgeons at specialist paediatric units and those performing more than 30 herniotomies in a year were more likely to open the inguinal canal without dividing the external ring in all age groups. There was quite obviously no standard surgical technique for inguinal herniotomy in children in this survey, and there are only trends. [ABSTRACT FROM AUTHOR]

Objective: To record the anatomical variations and clinical importance of the genital branch of the genitofemoral nerve in the inguinal canal. Design: Neuropathology study. Setting: General hospital, Taiwan. Subjects: 58 cadavers. Interventions: 116 dissections findings of the genitofemoral nerve in the inguinal canal. Main outcome measures: Anatomical variations. Results: All the genital branches passed through the ventral aspect of the internal ring. Almost all these branches entered the ring and continued within the spermatic cord between the fibres of the cremaster and the internal spermatic fascia. In 59% the nerve was related to the inferior fibres and in 38% it was in relation to the lateral or medial fibres. In only 3% did the genital branch run outside the spermatic cord. Conclusion: To avoid damage to the genital branch of the genitofemoral nerve, suturing should be done over the dorsal aspect of the internal ring. The cremaster should be incised longitudinal rather than transversely and the genital branch of the genitofemoral nerve should be identified before repair of the posterior wall. [ABSTRACT FROM AUTHOR]

Inguinal hernia is the most frequent defect of the front abdominal wall and it takes about 80% of these cases. It happens 10 times more common in males than females, because of the particularity of embrional development of urinary and reproductive systems,which leads to anatomic specification of inguinal canal of males. Contemporary treatement of inguinal hernias is linked with the methods of Shouldice and McVay, also the method of Lichtenstein. Another method is laparoscopic hernioplastica, which is not subject of our investigation. Its aim is to establish the unition of first two groups of methods, especially the operation of McVay with implantation of prolene patch. The subject of investigation are 107 patients,all men, operated by this method. All of them were profilacted periopertive with cephalosporines(third generation or higher) to reduce the risk of patch infection. The results are encouraging - recidive was observed with only one patient in the first six postoperative months. Long-term recidives are not excluded,but we do not have enough information about them. It makes impression the high percentage of inflammatory processes observed after the intervention, which we attach to technical faults, not good enough perioperative sterility, or not good enough preoperative aseptic cleanup. Postoperative hematoma was established in 6,54% of the patients,but its treatment did not cause any complications. The restricted number of operated patients is not enough to make a whole conclusion about the population. Nevertheless, the good results gives us a reason to recommend it to experienced surgeons under certain conditions. [ABSTRACT FROM AUTHOR]