Transversalis fascia !
The transversalis fascia is a thin layer lining the inside of the abdominal wall; weak spots in it in the groin are where inguinal hernias form.
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What it is
A thin sheet lining the inside of the abdominal muscles, just outside the peritoneum.
What it does
The layer that a hernia pushes through; in laparoscopic hernia repair the mesh is laid against it.
Key facts
- Where
- Deep to transversus abdominis, between it and extraperitoneal fat; part of the endoabdominal fascia
- Attaches
- Iliac crest and inguinal ligament; continuous with iliac and psoas fascia; evaginates at deep inguinal ring as internal spermatic fascia
- Function
- Forms posterior wall of inguinal canal; weak area in Hesselbach's triangle is where direct inguinal hernias push through
Relations
- Superficial
- Transversus abdominis and its aponeurosis; below the arcuate line, the rectus abdominis
- Deep
- Extraperitoneal (preperitoneal) fat and parietal peritoneum; the inferior epigastric vessels run in this fat before entering the rectus sheath
- Above
- Continuous with the fascia on the undersurface of the diaphragm
- Below
- Attaches to the iliac crest and the inner edge of the inguinal ligament; thickened as the iliopubic tract and carried into the thigh as the femoral sheath
- Behind
- Continuous with the fascia over quadratus lumborum and psoas major (the endoabdominal fascia)
How to find it
In open groin repair it is the thin posterior wall of the inguinal canal seen once the spermatic cord is lifted. At laparoscopy it is reached by lifting the peritoneum and extraperitoneal fat off the inside of the wall.
On imaging
Not seen as a separate layer on radiographs. On CT and ultrasound it is a thin line deep to transversus abdominis, hard to separate from the muscle, with extraperitoneal fat behind it. In the groin it is a key landmark: a direct inguinal hernia pushes through its weak area medial to the inferior epigastric vessels, which ultrasound and CT use to tell direct from indirect hernias.
Common problems
- Hernias: a weak spot lets fat or bowel bulge through (groin, belly button, old incisions).
- Muscle strains.
How it is diagnosed
Examination, often while coughing or standing; ultrasound or CT if unclear.
Treatment
- Hernias that cause symptoms are repaired, usually with a mesh.
Clinical notes
- Direct hernias bulge through a thinned transversalis fascia; tissue repairs (such as the Shouldice technique) rebuild it in layers
- Laparoscopic repair landmarks: the triangle of doom (between ductus deferens and testicular vessels, over the external iliac vessels) and the triangle of pain (lateral, below the iliopubic tract, with the lateral femoral cutaneous nerve and femoral branch of the genitofemoral nerve) are kept free of tacks
- The femoral canal, the medial compartment of the femoral sheath, is the path of the femoral hernia
- At the deep ring it forms the internal spermatic fascia, the innermost covering of the spermatic cord
Related conditions
Test yourself
Think of the answer, then tap the question to see it.
Which inguinal hernia pushes through the transversalis fascia in Hesselbach triangle?
The direct inguinal hernia, through a thinned transversalis fascia; the deep inguinal ring, entry of the indirect hernia, is itself a hole in this fascia.
What does the transversalis fascia form at the deep inguinal ring?
The internal spermatic fascia, the innermost covering of the spermatic cord.
What does the transversalis fascia become in the thigh?
The front wall of the femoral sheath (iliac fascia forms the back); its medial compartment, the femoral canal, is the path of a femoral hernia.
Where is the mesh placed in laparoscopic groin hernia repair?
In the preperitoneal space just deep to the transversalis fascia, covering the direct, indirect and femoral openings at once.
Educational information, not medical advice. For any symptom, see a health professional.
Its names
- Official Latin (TA2)
- fascia transversalis TA2 2389
- Official Spanish (DeCS)
- Fascia transversal
- English (TA2)
- Transversalis fascia
Related
Sources: Terminologia Anatomica (TA2); Anatomy, Abdomen and Pelvis: Anterolateral Abdominal Wall Fascia.
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Representative model, for educational purposes only.
