A surgeon performs a McVay (Cooper's ligament) repair for a recurrent inguinal hernia. Which additional structure must be incised to allow the tissue to reach Cooper's ligament without tension, and which vessel is placed at risk if this step is done carelessly?

• A Gimbernat's ligament preserved; obturator artery at risk
• B Inguinal ligament divided; external iliac artery at risk laterally
• C Lacunar ligament incised; femoral vein at risk medially ✓
• D Rectus sheath released; inferior epigastric vessels at risk

Explanation

In the McVay repair the conjoint tendon is sutured to Cooper's (pectineal) ligament. Because Cooper's ligament lies deeper than the inguinal ligament, the lacunar (Gimbernat's) ligament is incised to bring the tissues down without tension. The femoral vein runs immediately lateral to the lacunar ligament, so careless incision or over-tight suturing can injure or compress it. This repair also narrows the femoral canal, which is why it suits femoral as well as recurrent inguinal hernias.

Reference: Bailey and Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.