The anatomic structure of the preperitoneal tissue (PPT) of the inguinal canal

Anatomical examinations of the inguinal canal exist in many forms. The preperitoneal tissue, the structure directly adjacent to the transverse fascia, was examined in 62 cadavers. The left side of the inguinal abdominal wall was studied with special interest in the transverse fascia and the adjacent preperitoneal tissue. In 75% of the cases the transverse fascia and preperitoneal tissue built a continuous layer. A differentiation was difficult in cadavers with cachexia or an average nutritive state. The tissues could be differentiated without difficulty in individuals with adipositas. In these cases no connection between the two layers was detected. In the medial part of the inguinal abdominal wall the tissue thickness was larger than in the lateral part. However in 32% of the cases the tissue thickness was reverse. As a consequence, the isolated suture of the transverse fascia in inguinal hernia repair is anatomically virtually impossible, if both tissues build one continuous layer.