Spermatic cord and indirect hernias

[David M]

Have no idea if that picture will post. Let’s see.

[David M]

Ok, that didnt work and I missed the edit window.

There’s a good picture of the spermatic cord contents here.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7393947/

So, I have a question that might seem dumb. When the indirect hernia comes down through the cord, within which layer does the hernia sac lie?

Ive been assuming that the major purpose of stripping away the cremasteric muscle is to get to the hernia sac, so does it come down between the muscle and the internal spermatic fascia?

Thanks for anyone who can shed light on this.

[Good intentions]

That is an interesting question, especially since you often read of ligation of the hernia sac for indirect hernias. I found a paper that seems to describe what that material would be. A residual pouch of peritoneum material. It has also has some other interesting comments, re the shutter action and other things.

https://citeseerx.ist.psu.edu/document?repid=rep1&type=pdf&doi=336676c6a2da0e232c3cdff5af09b05b43894146

Here’s an excerpt –

“…
An indirect hernia is generally believed to have a congenital component which requires a potential hernia sac, i.e. the processus vaginalis. After the descent of the foetal testis into the scrotum from the retroperitoneum, the processus vaginalis should obliterate [3]. If the processus vaginalis is not obliterated, fat or bowel may get into it.
…”

[David M]

In this article it says that the sac is found within the internal spermatic fascia.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4455911/#:~:text=Indirect%20inguinal%20hernias%20are%20usually,external%20spermatic%20fasciae1%E2%88%923.

[Author]

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