Transversalis Fascia

fascia transversalis

The transversalis fascia is the layer of connective tissue lining the internal surface of the transversus abdominis muscle, forming part of the endoabdominal fascia. It is the most important fascial layer for hernia repair biomechanics, as it defines the preperitoneal space (between the fascia and the peritoneum) where prosthetic mesh is placed. The deep inguinal ring is an opening in the transversalis fascia.

Anatomical Data

Boundaries & Contents

Location	Inner surface of the anterior and lateral abdominal wall, between transversus abdominis and the extraperitoneal fat
Boundaries	Continuous with the other parts of the endoabdominal fascia (diaphragmatic, iliac, psoas and pelvic fasciae) Attached below to the iliac crest, inguinal ligament and pecten pubis Lines the back of the rectus abdominis below the arcuate line Opened by the deep inguinal ring
Contents	Deep inguinal ring, transmitting the spermatic cord or round ligament of the uterus Inferior epigastric vessels lie just behind it

Biomechanics

Function & Actions

Forms the main part of the posterior wall of the inguinal canal and gives the internal spermatic fascia to the spermatic cord. It is the key layer repaired or reinforced in hernia surgery.

Clinical Relevance

Clinical Notes

The transversalis fascia is the critical layer in hernia repair anatomy. The Shouldice repair reinforces the transversalis fascia in multiple layers with non-absorbable sutures for direct inguinal hernia. Total extraperitoneal (TEP) laparoscopic hernia repair works in the preperitoneal space between the transversalis fascia and the peritoneum. The deep inguinal ring weakness in indirect hernias is a defect in the transversalis fascia through which the hernia sac enters the inguinal canal. Mesh in open inguinal hernia repair (Lichtenstein) or laparoscopic repair covers the entire transversalis fascia defect.

Pathology

Common Injuries & Conditions

Direct Inguinal Hernia Through Transversalis Fascia

Acquired weakness of the transversalis fascia forming the posterior inguinal canal wall (Hesselbach triangle) allows direct inguinal hernia protrusion medial to the inferior epigastric vessels, managed by mesh reinforcement of the transversalis fascia defect using the Lichtenstein technique or laparoscopic preperitoneal mesh placement.

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