Transversalis fascia: historical aspects and its place in contemporary inguinal herniorrhaphy

Since the introduction of the term "fascia transversalis" by Sir Ashley Cooper in 1840, this thin layer of tissue has been discovered, denied, and redefined. The transversalis fascia was originally described as a bilaminar membrane. Although most subsequent descriptions do not reflect this analysis, some authors, especially in the surgical literature, believe that a posterior lamina of the transversalis fascia exists. Others believe that the posterior lamina of the transversalis fascia is, in fact, part of the preperitoneal fascia. The usefulness of the transversalis fascia and its derivatives or analogues; e.g., the crura of the deep inguinal ring, have also been extensively discussed. The aim of this paper is to provide a brief survey of the historical literature concerning the transversalis fascia and a discussion of some of the contemporary views on its morphology and significance in current laparoscopic hernia repair.