Morphometry of the Myopectineal Orifice: Relevance in Prosthesis Hernia Repair.

Abstract

Background: All groin hernias occur through a weakness at the lower extremity of the abdomen: the myopectineal orifice (MPO). Open preperitoneal and laparoscopic techniques involve dissection and placement of the prosthetic mesh to cover all potential hernia sites of the MPO. We re-examined the preperitoneal anatomy with the aim of determining the minimum ideal shape and size of prosthetic mesh for the repair of inguino-femoral hernias. Methods: Dissection was performed on 15 preserved human adult cadavers of both sexes. The preperitoneal approach was used to access the myopectineal orifice and its shape and dimensions obtained from tracings. The surface area was obtained by point counting. Results: The shape of the MPO was trapezoid and its area 7.0 ± 1.29cm2. The maximum length was 5.7cm and the maximum width 2.9cm. The point of maximum width varied along the length and the area of the MPO was significantly larger in male. Conclusion: For preperitoneal placement of prosthesis, a rectangular mesh measuring 15cm by 12cm is appropriate. These dimensions ensure adequate coverage and overlap of all the potential hernia sites in the groin, as well as allowing for mesh shrinkage.