Location and anatomy
The transversus fascia is a part of the endoabdominal fascia (fascia endoabdominalis) directly adjacent to the transversus abdominis muscle (m. transversus abdominis).
- In the upper abdomen, it is thin.
- Inferiorly, approaching the inguinal ligament, the fascia thickens, turning into a dense fibrous plate.
- From the inside, the fascia is fused with the parietal peritoneum.
- The transversus abdominis muscle tensions the transversus fascia and actively participates in the act of expiration and the function of the abdominal press.
How does it participate in forming the inguinal canal?
The fascia forms the posterior wall of the oblique slit-like inguinal canal. Medially, this wall is reinforced by the conjoint tendon (falx inguinalis / conjoined tendon) and the interfoveolar ligament (lig. interfoveolare, Hesselbach's ligament).
- Deep inguinal ring (anulus inguinalis profundus) is an oval opening in the transversus fascia measuring approximately 2.5–3.0 × 1.0–2.5 cm. It is located lateral to the inferior epigastric vessels (a. et v. epigastricae inferiores), which is a critically important landmark in surgery.
- In the area of the deep ring, the fascia forms a funnel-shaped depression extending into the canal.
- From the edges of the ring, the fascia continues onto the spermatic cord in men, forming the internal spermatic fascia (fascia spermatica interna).
What is its role in the rectus sheath?
The topography of the transversus fascia changes depending on the level relative to the arcuate line (linea arcuata), located approximately 4–5 cm below the umbilicus:
- Above the linea arcuata: the posterior wall of the sheath is formed by the deep lamina of the internal oblique aponeurosis and the transversus abdominis aponeurosis; the transversus fascia and parietal peritoneum also lie posterior to the rectus muscle.
- Below the linea arcuata: the aponeuroses of all three lateral muscles pass anterior to the rectus muscle. Only the transversus fascia and the parietal peritoneum remain posterior to the muscle. This creates a zone of relative anatomical weakness associated with hernia formation.
Topography and adjacent structures
The transversus fascia is closely connected with other anatomical structures of the abdominal wall and pelvis:
- Femoral canal: normally does not exist; it appears when organs protrude from the abdominal cavity beneath the inguinal ligament into the vascular lacuna. The transversus fascia of the abdomen continues into the vascular lacuna as the femoral septum (septum femorale). The canal is also formed with the participation of the inguinal and pectineal ligaments.
- Retroperitoneal adipose tissue: proper retroperitoneal fat is located directly behind the fascia retrorenalis. During surgical access, for example, through an 8–10 cm incision at McBurney's point, the transversus fascia is separated after blunt dissection of the internal oblique and transversus muscles, directly before opening the peritoneum. Preperitoneal adipose tissue is visualized behind the fascia.
Clinical significance in hernia repair
The transversus fascia is a key element in abdominal wall surgeries, as the posterior wall of the inguinal canal is its weakest point.
- Bassini method: aimed at strengthening the posterior wall. The transversus fascia is incised with a scalpel a few millimeters above the inguinal ligament, from the medial edge of the deep ring to the pubic tubercle. Then, a single musculofascial edge ("triple layer": internal oblique, transversus abdominis muscles, and transversus fascia) is isolated and sutured to the inguinal ligament posterior to the spermatic cord.
- Postempski method: the deep ring is displaced laterally, and the transversus fascia along with the internal oblique and transversus abdominis muscles is sutured to the inguinal ligament to completely eliminate the inguinal canal and relocate the spermatic cord into the subcutaneous tissue.
Class and exam questions
What passes through the deep inguinal ring formed by the transversus fascia?
In men, the spermatic cord passes through it, and in women, the round ligament of the uterus. From the edges of the ring, the fascia continues as the internal spermatic fascia covering the contents of the canal.
Why is the lower third of the rectus sheath considered a weak spot?
Below the arcuate line, located approximately 4–5 cm below the umbilicus, the aponeuroses of all lateral muscles pass to the anterior wall. Only the transversus fascia remains posterior to the rectus muscle, making this zone relatively weak.
What important vascular landmark is located near the deep inguinal ring?
The deep inguinal ring is located lateral to the inferior epigastric vessels (a. et v. epigastricae inferiores). It is critically important to account for them when incising the ring during incarcerated hernia surgery to avoid damage.
How is the transversus fascia used in Bassini inguinal hernia repair?
The fascia is incised, separated from the peritoneum, and then sutured into a single block with the internal oblique and transversus abdominis muscles. This "triple layer" is sutured to the inguinal ligament posterior to the posterior wall of the canal to reinforce it.
What else to study on this topic
- Inguinal canal (canalis inguinalis)
- Rectus sheath (vagina m. recti abdominis)
- Femoral canal (canalis femoralis)
- Endoabdominal fascia (fascia endoabdominalis)
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