Hernioplastia inguinal de Jean Rives modificada / Modified Jean Rives Inguinal Hernioplasty

Introducción: Las intervenciones quirúrgicas de hernias son uno de los procedimientos que más frecuente realizan los cirujanos. Objetivo: Caracterizar a los pacientes a los que les fue realizada la técnica quirúrgica de hernioplastia inguinal según la técnica de Jean Rives modificada. Métodos: Se realizó un estudio descriptivo retrospectivo de corte longitudinal en el Hospital Universitario Arnaldo Milián Castro de Santa Clara en el período de enero del 2011 a diciembre del 2021. El universo de trabajo estuvo representado por la población de pacientes con el diagnóstico de hernias inguinocrurales, a los cuales les fue efectuada dicha técnica quirúrgica. La muestra estuvo conformada por 194 pacientes. Resultados: Predominó el sexo masculino 103 (53,1 por ciento) y los pacientes mayores de 60 años 99 (51,0 por ciento). La localización más frecuente de la hernia fue la zona inguinal derecha 146 (75,3 por ciento) para ambos sexos, masculino 81 (41,8 por ciento) y femenino 65 (33,5 por ciento) respectivamente. Prevalecieron las hernias inguinales primarias 96 (49,5 por ciento), directas 70 (36,1 por ciento); en el sexo masculino preponderaron las indirectas 61 (31,4 por ciento). Predominaron las complicaciones posoperatorias en las cirugías de urgencias 10 (5,0 por ciento). El seroma 4 (2,0 por ciento), la orquitis 3 (1,5 por ciento) y la recidiva herniaria 3 (1,5 por ciento) fueron las complicaciones más comunes. Conclusiones: La técnica de hernioplastia inguinocrural de Jean Rives modificada es efectiva para los pacientes masculinos mayores de 60 años con hernias inguinales primarias, directas e indirectas. Las posibles complicaciones posoperatorias fueron en las intervenciones quirúrgicas de urgencia, donde el seroma y la orquitis fueron las más frecuentes. La recidiva tuvo una baja tasa con respecto a otros tipos de hernioplastias(AU)

Introduction: Hernia surgical interventions are one of the procedures most frequently performed by surgeons. Objective: To characterize the patients who underwent the surgical technique of inguinal hernioplasty based on the modified Jean Rives technique. Methods: A retrospective, descriptive and longitudinal study was carried out in Hospital Universitario Arnaldo Milián Castro, of Santa Clara City, central Cuba, in the period from January 2011 to December 2021. The study universe was represented by the population of patients diagnosed with inguinocrural hernias who underwent this surgical technique. The sample consisted of 194 patients. Results: There was a predominance of the male sex, accounting for 103 (53.1 percent); as well as of patients over 60 years of age, accounting for 99 (51.0 percent). The most frequent location of the hernia was the right inguinal area, represented by 146 cases (75.3 percent) for both sexes, accounting for 81 (41.8 percent) and 65 (33.5 percent) for males and females, respectively. Primary inguinal hernias predominated, represented by 96 cases (49.5 percent); as well as direct hernias, accounting for 70 cases (36.1 percent). In the male sex, indirect hernias predominated, accounting for 61 cases (31.4 percent). Postoperative complications predominated in emergency surgery, represented by 10 cases (5.0 percent). Seroma (4; 2.0 percent), orchitis (3; 1.5 percent) and hernia recurrence (3; 1.5 percent) were the most common complications. Conclusions: The modified Jean Rives inguinocrural hernioplasty technique is effective for male patients older than 60 years with primary, direct and indirect inguinal hernias. Potential postoperative complications occurred in emergency surgery, in which cases seroma and orchitis were the most frequent ones. Recurrence had a low rate compared to other types of hernioplasties(AU)

Five veins at the deep inguinal ring: can they reduce the chances of indirect inguinal hernia and increase the chances of varicocele? / Cinco venas en el anillo inguinal profundo. ¿pueden reducir las probabilidades de una hernia inguinal indirecta y aumentar las posibilidades de varicocele?

Complete duplication of testicular veins is a rare phenomenon. However, a few cases of duplication of gonadal veins have been reported. Here, I report a case of unusual formation and termination of the right testicular vein in an adult male cadaver. Five veins arose from the pampinniform plexus and entered the abdomen through the deep inguinal ring. The most medial among the five was large (3 mm in diameter) and it continued as a testicular vein and opened into the right edge of the inferior vena cava, 1 cm above the union of the common iliac veins. The other four veins were about 1 mm in diameter and they united to form two veins in front of the lower part of the right psoas and iliacus muscles (about 2 cm above the deep inguinal ring) and the two veins united to form upper testicular vein, 4 cm above the deep inguinal ring. This testicular vein was 3 mm in diameter and it opened into the inferior vena cava, 4 cm above the union of common iliac veins. Having five veins at deep inguinal ring might increase the chances of varicocele and decrease the chances of indirect inguinal hernia.

La duplicación completa de las venas testiculares es un fenómeno raro. Sin embargo, se han reportado algunos casos de duplicación de venas gonadales. En el presente trabajo se informa un caso de formación y terminación inusual de la vena testicular derecha en un cadáver de un hombre adulto. Cinco venas surgieron del plexo pampiniforme y penetraron en el abdomen a través del anillo inguinal profundo. El más medial entre los cinco fue de gran tamaño (3 mm de diámetro) y continuó como una vena testicular y se abrió hacia el margen derecho de la vena cava inferior, 1 cm por encima de la unión de las venas ilíacas comunes. Las cuatro venas restantes eran de 1 mm de diámetro aproximadamente, y se unieron para formar dos venas frente a la parte inferior de los músculos psoas e ilíaco derechos (aproximadamente 2 cm por encima del anillo inguinal profundo). Se unieron dos venas para formar la vena testicular superior, la cual medía 3 mm de diámetro y se abría hacia la vena cava inferior, 4 cm por encima de la unión de las venas ilíacas comunes. Cinco venas en el anillo inguinal profundo podrían aumentar las posibilidades de varicocele y disminuir las posibilidades de una hernia inguinal indirecta.

Influence of tobacco, alcohol and diabetes on the collagen of cremaster muscle in patients with inguinal hernias / Influência do tabaco, álcool e diabete sobre a interação célula-colágeno em músculo cremaster de humanos com hérnias inguinais

ABSTRACT Background: New findings point out that the mechanism of formation of the hernias can be related to the collagenous tissues, under activity of aggressive agents such as the tobacco, alcohol and diabetes. Aim: To analyze the collagen present in the cremaster muscle in patients with inguinal hernias, focusing the effect of tobacco, alcohol, and diabetes. Methods: Fifteen patients with inguinal hernia divided in three groups were studied: group I (n=5) was control; group II (n=5) were smokers and/or drinkers; and group III (n=5) had diabetes mellitus. All subjects were underwent to surgical repair of the inguinal hernias obeying the same pre, intra and postoperative conditions. During surgery, samples of the cremaster muscle were collected for analysis in polarized light microscopy, collagen morphometry and protein. Results: The area occupied by the connective tissue was higher in groups II and III (p<0.05). The collagen tissue occupied the majority of the samples analyzed in comparison to the area occupied by muscle cells. The content of total protein was higher in groups II and III compared to the control group (p<0.05). Conclusion: The tobacco, alcohol and diabetes cause a remodel the cremaster muscle, leading to a loss of support or structural change in this region, which may enhance the occurrences and damage related to inguinal hernias.

RESUMO Racional: Estudos recentes sinalizam que o mecanismo de formação das hérnias pode estar relacionado aos tecidos colagenosos, sob a ação de agentes agressores como o tabaco, o álcool e o diabete. Objetivo: Avaliar o colágeno presente no músculo cremaster em pacientes com hérnias inguinais enfocando o efeito do tabaco, álcool e diabete. Métodos: Foram estudados 15 pacientes com hérnias inguinais divididos em: grupo I (n=5) controles; grupo II (n=5) indivíduos fumantes e/ou etilistas; e grupo III (n=5) indivíduos que apresentavam diabete melito. Todos foram submetidos à correção cirúrgica das hérnias inguinais obedecendo às mesmas condições pré, intra e pós-operatórias. Durante o procedimento cirúrgico, amostras do músculo cremaster foram coletadas para análises em microscopia de luz polarizada, morfometria do colágeno e de proteínas. Resultados: A área ocupada por tecido conjuntivo foi maior nos grupos II e III (p<0,05). O tecido colágeno ocupou a maior parte das amostras analisadas, em comparação à área ocupada pelas células musculares. O conteúdo de proteínas totais foi maior nos grupos II e III, quando comparado com o grupo controle (p<0,05). Conclusão: O tabaco, o álcool e o diabete ocasionam remodelação no músculo cremaster, levando à perda de suporte ou alteração estrutural nesta região, podendo intensificar as ocorrências e os danos relacionados às hérnias inguinais.

¿Existe alteración de los mecanismos de degradación del colágeno de la matriz extracelular manifestada en la expresión de MMP2 y TIMP2 en pacientes con hernia inguinal primaria? / meDoes alteration of extracellular matrix collagen degradation chanisms manifested in the expression of MMP2 and TIMP2 in patients with primary inguinal hernia exists?

Existe evidencia de asociación de alteraciones de la matriz colágena en sujetos con hernia inguinal (HI). El objetivo de este estudio fue determinar la existencia de alteraciones en la expresión de MMP2 y TIMP2 en sujetos con HI primaria. Estudio de casos y controles, realizado en los Servicios de Cirugía y de Urgencias del Hospital Regional de Temuco entre 2009-2010. Se incluyeron pacientes con HI primaria mayores de 15 años, sin restricción de género (casos), e Individuos sin hernias, mayores de 15 años, intervenidos por apendicitis aguda (controles). Se excluyeron portadores de condiciones predisponentes al desarrollo de hernias de pared abdominal. La variable resultado fue determinación de MMP2 y TIMP2 mediante inmunohitoquímica (IHQ). Otras variables de interés estudiadas fueron: hábito tabáquico, antecedente familiar de hernia, historia de estreñimiento, peso, estatura e índice de masa corporal (IMC). Se utilizó estadística descriptiva; analítica y modelos de regresión logística. Se estudiaron 21 casos y 20 controles. El 73 por ciento correspondió a hombres. La edad promedio fue 55,3+/-18,9 y 38,9+/-16,9 para casos y controles respectivamente. No se observaron diferencias estadísticamente significativas en las variables sexo, estatura, peso, IMC y hábito tabáquico entre casos y controles. Se verificaron diferencias significativas en las variables, antecedente familiar de hernia e historia de estreñimiento (más frecuentes en casos). La tinción IHQ de MMP2, fue mayor en los casos (53,4 por ciento vs. 40,0 por ciento; p=0,5068), y la de TIMP2, fue mayor en los controles (35,0 por ciento vs. 23,8 por ciento; p=0, 7333). El análisis multivariado descartó confundentes. Con la metodología utilizada no se verificó asociación entre alteración de los mecanismos de degradación del colágeno, manifestados en la expresión de MMP2 y TIMP2, con el desarrollo de HI primaria.

There is some evidence of association b collagen matrix alterations in patients with inguinal hernia (IH). The aim of this study was to determine the existence of alterations in the expression of MMP2 and TIMP2 in patients with primary IH. Case-control study conducted in the Department of Surgery and Emergency of Temuco Regional Hospital in 2009-2010 periods. We included subjects with primary IH over 15 years, without gender restriction (cases) and subjects without hernias, aged 15, underwent surgery for acute appendicitis (controls). Patients with conditions predisposing to the development of abdominal wall hernias were excluded. End point was determination of MMP2 and TIMP2 by Immunohistochemistry (IHC). Other studied variables were: smoking, family history of hernia, history of constipation, weight, height and body mass index (BMI). Descriptive statistics, analytical and logistic regression models were used. 21 cases and 20 controls were studied. 73 percent were men. The average age was 55.3+/-18.9 and 38.9+/-16.9 for cases and controls respectively. There were no statistically significant differences in the variables sex, height, weight, BMI and smoking between cases and controls. Significant difference was found in the variables, family history of hernia and history of constipation (more common in cases). IHC staining of MMP2 was higher in cases (53.4 percent vs. 40.0 percent, p=0.5068) and IHC of TIMP2 was higher in controls (35.0 percent vs. 23.8 percent, p=0.7333). Multivariate analysis discarded confounders. With the methodology used has not been tested association between alteration of mechanisms of collagen degradation, manifested in MMP2 and TIMP2 expression with primary IH development.

Unusual manifestation of Marden-walker syndrome.

Marden-Walker syndrome (MWS) is characterized by multiple joint contractures, a mask-like face with blepharophimosis, micrognathia, high-arched or cleft palate, low-set ears, decreased muscular bulk, arachnodactyly, and kyphoscoliosis. We report a case of MWS along with unusual manifestation of neurological, cardiovascular, and genitourinary system.

Gall stone in a port-site hernia sac: incidential finding

Gall bladder perforation during laparoscopic cholecystectomy with spillage of bile and gall stones is relatively common. Herein, we present a very rare case of incidentally found gall stone in an umbilical port-site hernia sac. A 45 years old emirates lady was admitted to Ghayathi general hospital for repair of port site hernia in the umbilical region 2.5 years after laproscopic cholecystectomy. lntraoperatively, the hernia sac was found to contain a freely mobile faceted stone of about 1 x 1.5 x 1 cm in size over the surface of the contained omentum. Stone was retrieved and the hernia was tackled. Literature was reviewed along with med-line search over the past 15 years where we could find 4 cases only reported

Quantitative and qualitative analysis of collagen types in the fascia transversalis of inguinal hernia patients

BACKGROUND: Inguinal hernia is the second most common surgical case in our field. The anatomical factors alone are not enough to explain the inguinal hernia. Studies show changes in the proportion and quantity of collagen fibers in the developing of inguinal hernia. The greater production of collagen type III compared to the type I could justify the thinning of the fascia transversalis and its weakness. AIM: To determine the quantitative and qualitative changes of collagen in the fascia transversalis in inguinal hernia patients and compare them to findings from corpses without inguinal hernia. METHOD: Prospective case-control study based on the biopsy of fascia transversalis of 27 patients and 24 corpses. The technique used was hematoxylin-eosin and picrosirius colorimetry. RESULTS: The medium percent area of collagen (types I + III) and collagen type I, in both groups, show no statistic difference. The quantity of collagen type III was greater in the patients. Patients classified with Nyhus IIIa presented greater quantity of collagen type III. CONCLUSION: There is no significant difference in the quantity of collagen in the fascia transversalis of patients compared to the controls. An increase in the quantity of collagen type III was found in patients with inguinal hernia and a greater quantity in those patients classified with Nyhus IIIa.

RACIONAL: A hérnia inguinal é a segunda afecção cirúrgica mais comum em nosso meio. Os fatores anatômicos, isoladamente, não são suficientes para explicar a ocorrência das hérnias inguinais. Estudos apontam alterações na proporção e quantidade de fibras colágenas no desenvolvimento da hérnia inguinal. A maior produção de colágeno tipo III em relação ao tipo I poderia justificar o adelgaçamento da fascia transversalis e sua fraqueza. OBJETIVO: Determinar as alterações quantitativas e qualitativas de colágeno na fascia transversalis de doentes com hérnia inguinal e compará-las com achados em cadáveres sem hérnia inguinal. MÉTODOS: Estudo prospectivo caso-controle com análise de biopsia de fascia transversalis de 27 doentes e 24 cadáveres. Utilizou-se a técnica de coloração de hematoxilina-eosina e picrosirius. RESULTADOS: A área percentual média de colágeno (tipo I + tipo III) e colágeno tipo I, nos dois grupos, não apresentou diferença estatística. A quantidade de colágeno tipo III foi maior nos doentes. Doentes classificados com Nyhus IIIa apresentaram maior quantidade de colágeno tipo III. CONCLUSÃO: Não há diferença significativa na quantidade de colágeno em fascia transversalis de doentes comparados com controles. Foi encontrado aumento na quantidade de colágeno tipo III nos doentes com hérnia e em maior quantidade nos doentes classificados como Nyhus IIIa.

Hernia femoral: estudio de la pared posterior del canal inguinal / Study of the posterior wall of inguinal channel in patients with femoral hernia

El objeto del presente estudio es describir la anatomía de la pared posterior del conducto inguinal (PPCI) y los hallazgos anatomopatológicos en estos pacientes. Se trata de estudio descriptivo, prospectivo, que se efectuó en 23 pacientes, 5 varones y 18 mujeres, intervenidos consecutivamente por hernia femoral a partir del mes Julio de 2000, en el Centro de Referencia de Salud Cordillera Oriente. La vía de abordaje fue inguinal y se asoció a una disección de las estructuras del canal inguinal estableciendo el trayecto y modo de inserción del tracto iliopúbico (TIP) y de la aponeurosis del músculo transverso (AMT) en el ligamento pectíneo y la presencia de hernias o debilidad de la pared posterior del canal inguinal. Tanto la inserción del TIP como la de la AMT estuvieron desplazadas hacia medial, rodeando el canal de la hernia. En 8 casos se apreció una debilidad manifiesta de la PPCI y en 10 (43,4 por ciento) una hernia inguinal. En 1 paciente se encontró una hernia inguinal directa y en 9 hernias lipomatosas de diversos tamaño que emergían por el anillo inguinal profundo o a través de la pared posterior debilitada. Concluimos que las hernias inguinales son frecuentes y que la PPCI está debilitada en los pacientes con hernia femoral. Estos hallazgos explican al desgarro de la PPCI observada en 3 de nuestros pacientes al suturar el TIP al ligamento pectíneo. No se puede descartar que la herniorrafia femoral saturando el TIP al ligamento pectíneo acreciente la debilidad de la PPCI.

Cure de hernie inguinale sans tension : technique de Lichtenstein modifiee par Chastan

L'etude a porte sur 40 patients presentant une hernie inguinale. L'objectif etait d'evaluer les resultats de la technique de LICHTENSTEIN modifiee Chastan ( sans tension ). Il s'agit d'une etude prospective de 15 mois realisee dans le service de chirurgie A de l'Hopital National du Point G; allant de Mai 2002 a Aout 2003. Les resultats de l'etude ont montre une predominance masculine de 85; avec un sexe ratio de 5;67 en faveur des hommes. Les motifs de consultation ont ete la tumefaction et la douleur inguinale (75). La hernie siegeait a gauche en majorite 47;5. Le type oblique externe etait plus represente 57;5. Les etiologies ont ete l'age et l'effort avec 40. 10 recidives ont ete opere 25. L'anesthesie peridurale 52;5a ete plus utilisee ; anesthesie locale 11 cas dont 4 cas en ambulatoire ; la rachianesthesie 8 cas. 2O cas de resection du sac herniaire ont ete observes. La duree moyenne du temps operatoire a ete de 55;75 minutes. L'antibiotique etait systematique avec une duree moyenne de 12;17 jours. L'analgesie a dure en moyenne 1;92 jours. Les compli- cations immediates ont ete : 2 cas d'infections parietales (5) et 8 cas de douleurs (20). La duree moyenne d'hospitalisation etait de 1;44 jours. La duree moyenne d'arret du travail a ete de 21;21 jours. A 1 mois de suivi un cas de tumefaction testiculaire etait observe 2;5. A 3 mois de suivi nous avons eu 1 cas de nevralgie (2;5) et 1 cas de recidive (2;5). Le cout total de l'intervention etait en moyenne 99 454;10 F CFA. Les patients ont ete satisfaits en majorite 95. Cette etude nous a permis de verifier que cette technique sans tension est pratiquable dans les conditions du Mali et peut se faire en ambulatoire (4 cas / 40 cas). Le cout de la prothese est eleve mais le risque de recidive est peu eleve

Alterações moleculares do gene da elastina nos pacientes portadores de hérnia inguinal / Molecular alterations of elastin gene in inguinal hernia patients

O objetivo do presente estudo foi verificar a ocorrência de mutações do gene da elastina nos pacientes portadores de hérnia inguinal. Estudou-se o DNA genômico de 19 pacientes com hérnia inguinal e 16 controles. Os 34 exons do gene foram amplificados e foi realizada a análise conformacional de fita simples. Observou-se bandas anormais no exon 20. O seqüenciamento do exon 20 revelou uma dupla substituição de bases no códon 404 em 78 por cento e 50 por cento dos pacientes idosos e adultos com hérnia inguinal respectivamente e a substituição de uma base no códon 422 em todos os pacientes com hérnia inguinal, em todos os indivíduos controles idosos e em 37,5 por cento dos indivíduos controles adultos. É possível que estas mutações possam estar relacionadas à produção de moléculas de elastina alteradas e desempenhem papel na gênese da hérnia inguinal.The present study was designed to verify the presence of elastin gene mutations from genomic DNA in patients with inguinal hernia. Nineteen adult patients with diagnosed inguinal hernia and 16 controls were analyzed. All 34 exons were amplified and mutations were sought by single strand conformation polymorphism. DNA amplification revealed an abnormal band in exon 20. Sequencing showed a double base substitution in codon 404 in 78 per cent of the elderly hernia patients and in 50 per cent of the younger hernia group. It also revealed a single base substitution in codon 422 in all inguinal hernia patients, in all the elderly controls as well as in 37,5 per cent of the younger controls. It is possible that these elastin mutations may be responsible for the production of abnormal elastic fibers, thus playing a role in inguinal hernia genesis...

Richter's hernia: a rare presentation of abdominal tuberculosis.

Intestinal obstruction due to Richter's hernia has not been reported in abdominal tuberculosis. This 21-year-old man with abdominal tuberculosis presented with small gut obstruction due to Richter's hernia associated with ascites and patent right processus vaginalis (PV). He underwent laparotomy with reduction of Richter's hernia and closure of the PV at the right deep inguinal ring.

Apendicite aguda apos hernioplastia inguinal laparoscopica: coincidencia ou complicacao? / Acute apendicitis after laparoscopic inguinal hernioplasty: coincidence or complication?

Alguns casos de complicacao intra-peritoneal relacionados a correcao laparoscopica da hernia inguinal pela tecnica transabdominal foram descritos. Os autores relatam o primeiro caso de apendicite aguda no pos-operatorio de um paciente submetido a resseccao transuretral de prostata e hernioplastia inguinal bilateral pela tecnica TAPP que levou o paciente a uma segunda intervencao laparoscopica

Origen anómalo de la arteria epigástrica inferior / Anomalous origin of the epigastric inferior artery

La arteria epigástrica inferior se origina normalmente desde la arteria ilíaca externa, próxima al ligamento inguinal. En la cara posterior del músculo recto abdominal se anastomosa con las ramas de la arteria epigástrica superior, rama terminal de la arteria torácica interna. Describimos dos casos de origen bajo de la arteria epigástrica inferior, encontrados en disecciones de rutina efectuadas en la Unidad de Anatomía Descriptiva y Topográfica de la Facultad de Medicina de la Universidad de La Frontera, Chile. Las variaciones fueron encontradas, unilateralmente, en dos individuos adultos, de sexo masculino. Las arterias epigástricas inferiores se originaban de la arteria femoral profunda, ascendían por la parte medial de ella, alcanzaban el ligamento inguinal y penetraban en la cavidad pélvica, donde daban origen en un caso a la arteria cremastérica (pequeña) y una rama púbica (de mayor volumen) y en el otro, a una rama obturatriz la cual se curvaba para adosarse a la pared pélvica. La arteria epigástrica inferior es muy importante no sólo por sus anastomosis, sino también por sus relaciones anatómicas con el conducto deferente en el hombre y ligamento redondo en la mujer, y además por la estrecha relación que presenta con los cuellos de los sacos herniarios inguinales

The internal oblique muscle in the pathogenesis of the inguinal hernia / O músculo oblíquo interno do abdome na patogenia das hérnias inguinais

The search for an anatmoic justification for the occurrence of the inguinal hernia led to the study of the inferomedial attachment of the internal oblique abdominis muscle in 84 inguino-hypogastric regions of individuals not presenting inguinal hernia and in 84 inguino-hypogastric regions of individuals presenting inguinal hernia. It was concluded that the inferomedial attachment of the internal oblique abdominis may occur either at the pubis or the sheath of the recuts adominis, both in individuals bearing inguinal hernia and in those do not present this condition. The absence of public attachment in the inguinohypogastric region is similar whether or not the individual presents inguinal hernia. The absence of public attachment is of 96,55 (p<0,001) in areas with direct inguinal hernia, which means that the absence of publlic attachment of the internal oblique abdominis in the inguino-hypogastric regions presenting direct inguinal hernia may be the predisposing factor in the pathogenesis of this type of hernia.

Contribution to the anatomical study of the internal oblique muscle in the etiopathogenesis of the direct inguinal hernia

This paper discusses anatomical aspects of internal oblique muscle at the inguino-hypogastric area, particularly of its inferomedial insertion aiming at finding an anatomical substrate which justifies the appearance of direct inguinal hernia. Eighty-four inguino-hypogastric regions were studied in fresh corpes of 20 adult females and 64 adult males. It was noticed that the inferomedial aspect of the internal oblique muscle is either inserted into the pubis or the lateral margin of the recuts abbominis sheath, the former being more frequent: 95,0 per cent in females and 57,82 per cent in males (p<0,05). As far the insertion of the internal oblique muscle into the lateral margin of the recuts abdominis sheath is concerned, the distance between the pubic tubercle and the inferomedial insertion of the muscle is of up to 3,3 cm in males and up to 0,7 cm in females. If only the portion of the internal oblique muscle which does not exhibit gaps is considered, the inferomedial insertion is then located up to 4,5 cm from the pubis in males and up to 2,4 cm in females. The internal oblique muscle wasclassified into five categories according to its dysmorphism and it was noticed that gaps are more frequent in males. The data suggest that the less frequent insertion of the internal oblique muscle into the pubis and also the higher incidence of muscular dysmorphism of this muscle may be factors responsible for the higher frequence of direct hernias in males.