Cooper ligament (pectineal ligament) is a thick, strong fibrous band along the pectineal line of the superior pubic ramus, continuous with the periosteum, formed by the convergence of the lacunar ligament, pectineal fascia, and periosteum.
Provides the strongest attachment point in the posterior inguinal floor — the basis of the Cooper ligament repair (McVay repair) and laparoscopic hernia mesh fixation. Its strength makes it the preferred anchor for inguinal and femoral hernia repairs.
Cooper ligament fixation in hernia repair (McVay repair) closes the femoral canal by suturing the transversalis fascia to the Cooper ligament, effectively treating both inguinal and femoral hernias simultaneously. In laparoscopic hernia repair, tacks are placed into the Cooper ligament for reliable mesh fixation.
Open hernia repair suturing the transversalis fascia and conjoint tendon to the Cooper ligament, closing the femoral canal and addressing both inguinal and femoral hernias.
Mesh secured to the Cooper ligament using tacks during laparoscopic TAPP hernia repair, providing the most reliable inferior mesh fixation point.
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