Are the sutures between the two flaps of the external oblique aponeurosis not under traction?
The external oblique aponeurosis is transversally very elastic. The sutures are executed in such a way as to avoid excessive traction and stress due to muscular contraction. The external oblique muscle contracts longitudinally and not transversally with respect to the suture line. Scarring is not impeded by the moderate tension of the suture, also because the aponeurosis receives a scarce blood flow and is, therefore, not subject to ischemia. Is there not traction on the inguinal ligament with consequent risk of iatrogenic crural hernia?The risk of iatrogenic crural hernia is minimal even in techniques like Shouldice’s, which perform direct sutures along the whole inguinal ligament. Much has been written about this point.In my technique only the most superficial part of the inguinal ligament is barely involved and in no way subjected to transversal traction. I can also say that, since I began exploring the crural ring, I have never encountered crural pseudo-recurrences in my patients,
