title: The secondary internal ring: applications to surgery of the inguinal canal.
abstract: OBJECTIVE
  In 1975 the clinical importance of the preperitoneal fascial or secondary internal ring was noted based on procedures performed through the suprainguinal preperitoneal approach. The importance of knowledge of the secondary internal ring in the performance of inguinal hernia repairs, orchiopexies and operations for impalpable testes through the inguinal canal is shown, along with a description of the anatomy of the internal ring and subjacent retroperitoneal connective tissue.
  
  
  METHODS
  More than 250 consecutive inguinal canal dissections were performed during surgery for inguinal hernia repair, orchiopexy or impalpable testes by a single surgeon using 3.5x magnification.
  
  
  RESULTS
  The intraoperative dissections clearly showed the existence of a secondary internal ring, which when opened provided wide access to the retroperitoneal space containing the internal spermatic vessels and vas deferens.
  
  
  CONCLUSIONS
  Knowledge of the anatomy of the secondary internal ring is an adjunct to the performance of operations through the inguinal canal.
mesh_terms: D003456:Cryptorchidism / Q000601:surgery*; D005205:Fascia / Q000033:anatomy & histology; D006552:Hernia, Inguinal / Q000601:surgery*; D006801:Humans; D007264:Inguinal Canal / Q000033:anatomy & histology / Q000601:surgery*; D008297:Male; D012187:Retroperitoneal Space / Q000033:anatomy & histology; D013737:Testis / Q000601:surgery