CHAPTER XX. 



THE INGUINAL REGION. 



ANATOMY. INGUINAL CANAL. 



HERNIA. 



Varieties of. Operations for. 



The inguinal region is covered by the integument and 

 the superficial fascia, the latter being divisable into two 

 layers. These layers are the subcutaneous, blending with 

 the superficial fascia of the rest of the body, and the deeper 

 layer Scarpa's separated from the subcutaneous by the 

 superficial epigastric vessels and by the lymphatics. This 

 deeper layer of the superficial fascia passes over Poupart's 

 ligament, and blends with the fascia lata of the thigh 

 immediately below it, while internally, it becomes part of 

 the dartos of the scrotum as already described. After 

 removal of these superficial structures the aponeurosis of 

 the external oblique is exposed, and that portion of it from 

 the anterior superior iliac spine to the pubic spine is 

 thickened, constituting Poupart's ligament. The outer 

 half of this ligament is obliquely directed, while the inner 

 half is almost horizontal and is twisted on itself, so as to 

 form a triangular band inserted into the pectineal line for 

 about one-half inch, and termed "Gimbernat's ligament." 

 The base of the latter ligament is directed outwards, the 

 apex inwards towards the spine of the pubes, and, in the 

 upright position of the body, its surfaces are superior and 

 inferior. Immediately above and external to the crest of 

 the pubes, the aponeurosis of the external oblique splits so 

 as to form a triangular-shaped area about one inch in 

 length and one-half inch in width at the base. Through 

 this cleft the spermatic cord finds exit, although it is not 

 clearly visible because of the prolongation over it of a thin 



