Anatomical pitfalls in the technique for total extra peritoneal laparoscopic repair for inguinal hernias

Faure, Jean‐Pierre; Doucet, Christelle; Rigouard, Ph.; Richer, Jean‐Pierre; Scépi, M.

doi:10.1007/s00276-006-0143-7

Cited by 10 publications

(18 citation statements)

References 16 publications

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“…It is now increasingly recognized that despite the merits of laparoscopic hernioplasty, extra-peritoneal anatomy and dissection in the groin is poorly understood by the most practicing surgeons. 4,[7][8][9][10] Inadequate understanding and improper dissection of pre-peritoneal anatomy is now regarded as the main cause of difficulties during total extraperitoneal preperitoneal (TEPP) hernioplasty for inguinal hernia with a long learning curve, leading to its lack of popularity despite the obvious advantages and better results. [7][8][9][10][11] In contrast to the general belief, anatomy of the groin is reported to be complex, especially in presence of anatomic variations reported by several investigators that received little/no attention of anatomists and practicing surgeons alike.…”

Section: Introductionmentioning

confidence: 99%

“…4,[7][8][9][10] Inadequate understanding and improper dissection of pre-peritoneal anatomy is now regarded as the main cause of difficulties during total extraperitoneal preperitoneal (TEPP) hernioplasty for inguinal hernia with a long learning curve, leading to its lack of popularity despite the obvious advantages and better results. [7][8][9][10][11] In contrast to the general belief, anatomy of the groin is reported to be complex, especially in presence of anatomic variations reported by several investigators that received little/no attention of anatomists and practicing surgeons alike. 8,10,[12][13][14][15] In 2001, Robert Bendavid declared that 'Nothing goes as far forward preventing complications as the surgeon's awareness and fear of them'.…”

Section: Introductionmentioning

confidence: 99%

“…2 The laparoscopic posterior approach does not follow the anatomy of the anterior approach for inguinal hernia repair, and this approach is also unfamiliar to the majority No doubt, the TEPP hernioplasty is now a wellrecognized technique with proven efficacy, reduced postoperative pain and low failure rate in addition to the early return to activity and work. 7 However, the operator often finds difficulties in execution of TEPP for no apparent reasons/cause, which are almost always attributed to lack of surgical skills or presence of adhesions. It is now increasingly recognized that despite the merits of laparoscopic hernioplasty, extra-peritoneal anatomy and dissection in the groin is poorly understood by the most practicing surgeons.…”

Section: Introductionmentioning

confidence: 99%

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Posterior rectus sheath variations: surgical significance and clinical implications for laparoscopic hernia surgeons

Ansari

2018

Int Surg J

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INTRODUCTIONThe current revolution of laparoscopic surgery has markedly altered the manners in how surgeons perceive and manipulate the anatomic tissues and planes of the human body. 1 The advent of laparoscopic surgery has generated a new field of live surgical anatomy called the laparoscopic anatomy, and understanding of systematic laparoscopic anatomy can provide the operating surgeons a clear procedural approach, and would immensely benefit the laparoscopic surgeons in training.2 The laparoscopic posterior approach does not follow the anatomy of the anterior approach for inguinal hernia repair, and this approach is also unfamiliar to the majority ABSTRACT Background: Laparoscopic hernia surgeon needs accurate knowledge of not only of target inguinal region but also of adjacent access areas, but he/she is severely constrained by absence of research work on laparoscopic live surgical anatomy in literature. Methods: Prospective study in patients who underwent laparoscopic total extra-peritoneal preperitoneal (TEPP) inguinal hernioplasty through 3-midline-port technique at Jawaharlal Nehru Medical College Hospital, Aligarh between 2010 and 2015. Results: Sixty-eight TEPP repairs were performed in 60 adult patients. Overall incidence of conversion to Open/TAPP hernioplasty was 4% of all cases, but conversion secondary to the anatomic variation of short PRS was seen in only 1.4% of all cases. The endvision and ease of procedure (EOP) were 8.20±1.33 and 7.27±2.05 visual analog score respectively, and both of them were adversely affected in presence of variant PRS anatomy. Average operation time (OT) for unilateral TEPP hernioplasty was 1.9 hours and it was adversely affected in presence of variant PRS anatomy. Overall incidence of surgical emphysema was 16%, and its development was significantly more in presence of variant PRS anatomy. Overall incidence of peritoneal injury, postoperative seroma, infection and chronic pain was 28%, 10%, 6.7% and 1.5% respectively, but they were not affected by variant PRS anatomy. Conclusions: Posterior Rectus Sheath Variations had significant impact on the intra-operative working but did not affect post-operative clinical outcome. Keen observation, timely recognition of anatomic variations and judicious dissection are essential keys for smooth conduct of the well-organized TEPP hernioplasty with ease, safety, rapidity and better results.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Posterior rectus sheath variations: surgical significance and clinical implications for laparoscopic hernia surgeons

Ansari

2018

Int Surg J

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“…[11,14,15] Laparoscopic total extraperitoneal preperitoneal (TEPP) hernioplasty has become a well-recognized established technique with proven efficacy, reduced post-operative pain and low failure rate, in addition to the early return to activity and work. [16,17] However, the learning curve of TEP hernioplasty is long and steep, and carries paramount importance for the beginners/ inexperienced surgeons. [18] The steep long learning curve is often discouraging to many surgeons who therefore declare the laparoscopic technique not worth for such a basic surgery.…”

Section: Introductionmentioning

confidence: 99%

“…[19] 'Initially, the dissection of the extraperitoneal space in the TEP approach tended to be difficult, confusing and therefore hard to learn'. [20] Therefore, it is a common observation worldwide that the young upcoming surgeons as well as the experienced surgeons not trained in the Section: Surgery laparoscopic hernioplasty find great difficulties in execution of the TEPP hernioplasty for no apparent reasons/causes which are almost always attributed to the lack of his/her surgical skills or presence of adhesions, although the main cause of difficulties in reality lies in the inadequate understanding of extraperitoneal fascial anatomy & improper dissection, [16,[21][22][23] leading to its lack of popularity despite the obvious advantages and better results. [19,24] The inguinal anatomy as viewed through the laparoscope is unfamiliar to most surgeons who often find the preperitoneal dissection tedious and frustrating.…”

Section: Introductionmentioning

confidence: 99%

Transversalis Fascia and Preperitoneal Fascia: A Laparoscopic Study of Live Surgical Anatomy during TEPP Hernioplasty – Final Report and Literature Review

Ansari¹

2017

AIMDR

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Background: Despite excellent perspective, bright lighting and high magnification afforded by preperitoneal laparoscopy, there is still little agreement among the practicing surgeons and anatomists about transversalis and preperitoneal fascias. Methods: Study Setting -Elective Clinical; Design -Prospective; Population -Adults (≥18 years); Place -J. N. Medical College Hospital, A. M. U., Aligarh; Procedure: Laparoscopic total extraperitoneal preperitoneal (TEPP) hernioplasty; Technique: Standard 3-midline-port technique; Method: Telescopic and instrument dissection; Data collection -Intraoperative documentation and/or video recording; Data analysis -SPSS (v. 21).Results: Sixty eight TEPP hernioplasties (Unilateral TEPP 52; Bilateral 8) were successful in 60 patients. Transversalis fascia was of three types -single diaphanous layer (60%), single membranous layer associated with little/no fat (15%) and thin flimsy layer (25%). Preperitoneal fascia was observed as a definite single membranous layer in 83% of the cases, and as a double membranous layer in the remaining 17%. Internal spermatic fascia was found as an extension analog of the preperitoneal fascia in all cases in the present study, with formation of a secondary internal inguinal ring at its beginning. Easily fissile avascular plane was consistently present between preperitoneal fascia and transversalis fascia, suggesting different embryological origins. Conclusion: Preperitoneal laparoscopy of inguino-pelvic region confirmed regular presence of easily recognizable preperitoneal fascia distinct from transversalis fascia in all cases, with an easily fissile avascular preperitoneal plane in between them. Transversalis fascia was invariably unilaminar but preperitoneal fascia was at times bilaminar. Instead of transversalis fascia, preperitoneal fascia formed internal spermatic sheath with a secondary internal inguinal ring.

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Radiologic Evaluation for Postoperative Groin Pain

Miller

Ishimitsu

Saouaf

2016

The SAGES Manual of Groin Pain

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Anatomical pitfalls in the technique for total extra peritoneal laparoscopic repair for inguinal hernias

Abstract: Photographic representations of surgical views are displayed, and detailed descriptions applicable to anatomical structures are presented.

Cited by 10 publications

References 16 publications

Posterior rectus sheath variations: surgical significance and clinical implications for laparoscopic hernia surgeons

Posterior rectus sheath variations: surgical significance and clinical implications for laparoscopic hernia surgeons

Transversalis Fascia and Preperitoneal Fascia: A Laparoscopic Study of Live Surgical Anatomy during TEPP Hernioplasty – Final Report and Literature Review

Radiologic Evaluation for Postoperative Groin Pain

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