Conjoint Tendon (Inguinal)

tendo conjunctivus (falx inguinalis)

The conjoint tendon is the combined aponeurotic insertion of the internal oblique and transversus abdominis on the pubic crest, forming the medial posterior inguinal canal wall. Direct inguinal hernias protrude through the weakened posterior canal wall medial to the deep ring — the conjoint tendon is the deficient structure. Open hernia repairs (Bassini, Shouldice) approximate the conjoint tendon to the inguinal ligament to rebuild this posterior wall.

Region: Abdomen

Biomechanics

Function & Actions

Reinforces the posterior inguinal canal wall to prevent direct inguinal hernia; the target of Bassini and Shouldice hernia repairs

Clinical Relevance

Clinical Notes

The Shouldice repair sutures the internal oblique and transversus aponeurosis to the inguinal ligament in four overlapping layers, reconstructing the conjoint tendon-inguinal ligament relationship. It achieves recurrence rates of less than 1% in experienced hands. Laparoscopic repair with mesh avoids the conjoint tendon manipulation but achieves comparable recurrence rates.

Pathology

Common Injuries & Conditions

Direct Inguinal Hernia

Conjoint tendon weakness allowing peritoneum herniation through the posterior inguinal canal managed with Shouldice repair or laparoscopic mesh.