Anatomy of the peritoneal aspect of the deep inguinal ring: Implications for laparoscopic inguinal herniorrhaphy

O’Malley, Kiaran; Monkhouse, W. S.; Qureshi, Majid A.; Bouchier‐Hayes, David

doi:10.1002/(sici)1098-2353(1997)10:5<313::aid-ca4>3.0.co;2-r

Cited by 9 publications

(3 citation statements)

References 5 publications

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“…Inguinal hernia recurrences reoperated again by the TAPP technique revealed upturned mesh and slippage of the recurrent hernia below the mesh. Thus, the weak point of fixation elements is the lower portion of the mesh, where no fixation is possible in the triangle of doom and the triangle of pain [20]. Self-adhesive meshes adhere well to the environment in this region as well, which explains the lack of recurrence in the MILS group as compared to three (1.4%) recurrences in the group treated with fixation elements.…”

Section: Discussionsupporting

confidence: 91%

Mini-incisional laparoscopic surgery (MILS) for inguinal hernia repair*

Hollinsky¹,

Patrì²,

Hollinsky³

et al. 2012

Eur Surg

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Background: As meshes markedly reduce recurrence rates following surgery for inguinal hernia, surgical methods employing meshes have become increasingly popular among surgeons. Innovations in laparoscopic surgery have enabled the surgeon to minimize the size of trocar incisions. This type of laparoscopy is therefore referred to as minimal incisional laparoscopic surgery (MILS).Methods: All inguinal hernia patients who reported at our department during the last two years were included in a prospective observational study. In order to assess the feasibility of the MILS technique as well as its benefits for the patient, we investigated and compared the following intra-and postoperative parameters of two laparoscopic TAPP (transabdominal pre-peritoneal) techniques (MILS-TAPP versus conventional-TAPP): operating times, perioperative complications, postoperative and chronic pain, abdominal wall mobility, and recurrence rates.Results: Of 462 patients aged 18 to 94 years (mean, 46 years), 559 inguinal hernias in 481 patients (86.1%) were treated by laparoscopic approach. The Lichtenstein technique was used to treat 65 hernias (11.6%). The mean operating time was 60 minutes for the conventional TAPP technique (n ¼ 217) and 56 minutes for the MILS technique (n ¼ 264). Postoperative abdominal wall mobility scored by Janda's method was significantly superior in the MILS group (4.6) than in the conventional laparoscopic group (3.7). Postoperative pain on the VAS scale was rated 1.3 in the MILS group versus 2.6 in the conventional TAPP group. Three (1.4%) recurrences occurred after the conventional TAPP technique, whereas no hernia recurrence occurred when a self-adhesive mesh was used.Conclusions: Minimization of trauma secondary to the trocar incision was able to reduce postoperative pain and improve abdominal wall mobility. The self-adhesive mesh may be inserted by the practiced laparoscopic surgeon with no delay, and optimizes incorporation in the groin by laminar mesh adhesion in the preperitoneal cavity.

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Section: Discussionsupporting

confidence: 91%

Mini-incisional laparoscopic surgery (MILS) for inguinal hernia repair*

Hollinsky¹,

Patrì²,

Hollinsky³

et al. 2012

Eur Surg

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“…10. The area between the internal inguinal ring, the vas deferens, and the gonadal vessels is referred to as the triangle of doom, due to the potential risk of nerve and vessel injury during hernia repairs [12]. The triangle of pain is located between the internal inguinal ring, the gonadal vessels, and the inguinal ligament.…”

Section: Lateral Femoral Cutaneous Nervementioning

confidence: 87%

Retroperitoneal anatomy of the iliohypogastric, ilioinguinal, genitofemoral, and lateral femoral cutaneous nerve: consequences for prevention and treatment of chronic inguinodynia

Reinpold¹,

Schroeder

Schroeder³

et al. 2015

Hernia

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Nerve injury during inguinal hernia repairs can be avoided by taking the topographic anatomy of the inguinal nerves into consideration. The most advantageous plane to look for the iliohypogastric and ilioinguinal nerve during posterior neurectomy is on the anterior surface of the quadratus lumborum muscle. For the surgical treatment of severe chronic inguinodynia, especially after posterior open or endoscopic mesh repair (TAPP/TEP), the retroperitoneoscopic or open retroperitoneal approach for posterior triple neurectomy can be considered.

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“…This finding was further clarified by O'Malley et al. [13]; in this cadaveric study, the authors measured the angle between the vas deferens and testicular vessels as they converge on the medial margin of the deep inguinal ring, and the thickness of tissue lateral to the deep inguinal ring where staples are most likely to be placed. They concluded that appreciating these measurements may be useful in the intraoperative prediction of the position of the vas deferens and external iliac vessels.…”

Section: Anatomymentioning

confidence: 81%