Some structural characteristics of the inguinal region in the northern Croatia

In studying anatomical samples of both inguinal hernia patients and healthy controls with no changes observable in the inguinal region, the authors aimed at investigating the constitution of the inguinal region in relation to the formation of inguinal hernia. The morphological investigation of 68 anatomical samples and 44 inguinal regions at autopsy, revealed that the length of the interspinal line, independent of sex, varies from 180 to 310 mm and is 63 to 132 mm removed from the pubic tubercle (the height of the anterior pelvic arch). Thus, in 35% of male and 22% of female subjects the height of the anterior pelvic arch exceeded 75 mm indicating a low position of the groin. The research carried out in 640 inguinal hernia patients and 186 controls indicated a shift towards higher values in the interspinal line in inguinal hernia patients as compared with the controls. In addition, the height of the anterior pelvic arch in patients with inguinal hernia conspicuously exceeded that observed in the controls. The present study undoubtedly shows that the number of muscle and connective structure variations of the inguinal region depends upon the position of the groin in relation to the interspinal plane. The authors therefore agree with the classification of these relationships to high, medial and low groin position. The high position of the pubic tubercles up to 75 mm removed from the interspinal spine is accompanied with the firm constitution of the entire inguinal region. Moreover, the medical position of pubic tubercles 75 to 90 mm removed from the interspinal line does not indicate the risk of developing inguinal hernia. On the other hand, the low position of the pubic tubercles more than 90 mm removed from the interspinal line is often due to the inferior constitution of the inguinal region. This group is regularly at higher risk of developing inguinal hernia, particularly with other risk factors being added as well. The identification of structural characteristics of the inguinal region therefore enables the selection of the most appropriate operation procedure, i.e. between the classic hernia repair and endoscopic approach for prosthetic mesh implantation.