The inguinal canal is an oblique passage through the anterior abdominal wall, approximately 4 cm long in adults, running from the deep inguinal ring (in the transversalis fascia, lateral to the inferior epigastric vessels) to the superficial inguinal ring (in the external oblique aponeurosis, above the pubic tubercle). Its anterior wall is the external oblique aponeurosis; posterior wall is the transversalis fascia and conjoint tendon; roof is the arching internal oblique and transversus; floor is the inguinal ligament.
The inguinal canal transmits the spermatic cord in males and the round ligament of the uterus in females. Indirect inguinal hernias enter the canal through the deep ring; direct hernias bulge through the posterior wall (Hesselbach triangle). Laparoscopic hernia repair (TEP or TAPP) visualises the canal from the preperitoneal side, placing mesh to cover the deep ring, direct space, and femoral canal. Open Lichtenstein repair reinforces the posterior wall with mesh from the inguinal side.
A patent processus vaginalis allows bowel or omentum to herniate through the deep inguinal ring and travel along the inguinal canal, presenting as a groin bulge extending into the scrotum; laparoscopic or open repair closes the ring and reinforces the posterior canal wall.
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