Amato Giuseppe, Calò Piergiorgio, Rodolico Vito, Puleio Roberto, Agrusa Antonino, Gulotta Leonardo, Gordini Luca, Romano Giorgio
Postgraduate School of General Surgery, University of Cagliari, Cagliari, Italy.
Department of General Surgery, University of Cagliari, Cagliari, Italy.
J Invest Surg. 2020 Mar;33(3):231-239. doi: 10.1080/08941939.2018.1497734. Epub 2018 Oct 31.
Double ipsilateral inguinal ("pantaloon") hernias and also the more advanced "combined" inguinal hernia involve disruption of the inguinal floor. In the case of pantaloon hernias, the medial boundary of the internal ring remains intact but in combined hernias this is fully disrupted, producing a single hernial protrusion. Deepening the pathophysiology of these hernias may be helpful in addressing hernia genesis, thus improving strategies for the treatment of this disease. A cohort of 22 patients who underwent inguinal hernia repair showed double ipsilateral (pantaloon) hernia, comprising distinct direct and indirect protrusions separated by a tissue septum. In 19 patients, the septal arrangement dividing the 2 hernias showed macroscopically evident structural damages, then excised and histologically studied. Different tissue markers were used for the identification of the structural damages. Macroscopically, the divisor septum represents the boundary between internal ring and Hesselbach's triangle. Anteriorly it is composed by fibers of the internal oblique and transverse muscles, which form a complex with the inferior epigastric vessels on the corresponding posterior side of the inguinal floor. In the patient cohort studied, this anatomical structure showed a progressive sufferance characterized by chronic compressive damage. The anatomical structure which separates the indirect and direct components of a pantaloon hernia, herein referred to as the "septum inguinalis", has been shown progressively alter in both macro- and microscopically until it f undergoes disruption with development of a combined hernia. Understanding of this anatomical concept may help surgeons to perform sound repairs of these complex hernias.
双侧腹股沟（“马裤型”）疝以及更严重的“复合性”腹股沟疝均涉及腹股沟管后壁的破坏。对于马裤型疝，内环的内侧边界保持完整，但在复合性疝中，该边界完全破坏，形成单一的疝突出。深入了解这些疝的病理生理学可能有助于解释疝的成因，从而改进这种疾病的治疗策略。一组22例接受腹股沟疝修补术的患者显示为双侧腹股沟（马裤型）疝，包括由组织隔膜分隔的明显的直疝和斜疝突出。在19例患者中，分隔两个疝的隔膜排列显示出肉眼可见的明显结构损伤，随后将其切除并进行组织学研究。使用不同的组织标记物来识别结构损伤。肉眼观察，分隔隔膜代表内环与海氏三角之间的边界。其前部由腹内斜肌和腹横肌的纤维组成，这些纤维与腹股沟管后壁相应后侧的腹壁下血管形成复合体。在所研究的患者队列中，这种解剖结构表现出以慢性压迫性损伤为特征的进行性病变。分隔马裤型疝的斜疝和直疝成分的解剖结构，在此称为“腹股沟隔膜”，已显示出在宏观和微观层面上逐渐改变，直至随着复合性疝的发展而发生破坏。理解这一解剖学概念可能有助于外科医生对这些复杂疝进行合理的修补。
