Surgical Anatomy of the Inguinal Region from a Laparoscopic Perspective

Annibali, Riccardo; Fitzgibbons, Robert J.; Quinn, Thomas H.

doi:10.1007/978-1-4419-8574-3_7

Cited by 6 publications

(9 citation statements)

References 13 publications

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“…[51] The Cooperian philosophy is still timely and rather more true in the current laparoscopic era for safe and successful outcome as emphasized recently by Annibali et al and Bhatia, [52,53] and it demands crisp precise flawless anatomical knowledge, [16,26,53] long strenuous laparoscopic learning, [16,21] and significant laparoscopic experience of >30-80 cases, [27,[55][56][57][58][59] for the seamless surgery, and that it also poses new Section: Surgery dangers of modern technological approaches, warranting more anatomic research. [28,33] Anecdotal experiences published in the literature indicate that the fascial arrangements and relationships of structures near the deep inguinal ring are unfamiliar from the laparoscopic perspectives and are not generally known to most of the laparoscopic hernia surgeons.…”

Section: Discussionmentioning

confidence: 99%

“…This is in contradiction to the conventional textbook teaching that the 'internal spermatic fascia' is formed by the transversalis fascia. [52,[80][81][82][83][84][85][86][87][88] Way back in 1946, Tobin et al documented for the first time that the innermost covering of the spermatic cord, [89] the internal spermatic fascia, was really derived from the preperitoneal fascia instead of the transversalis fascia. Moreover in 1945, Lytle documented a middle inguinal ring, [90] a secondary internal inguinal ring, formed by a separate fascial sling in addition to the deep/internal inguinal formed in the transversalis fascia.…”

Section: Preperitoneal Fasciamentioning

confidence: 99%

“…[22] However, in 1921, Braus termed all the tissues between the transversus abdominis and the peritoneum as the transversalis fascia. Use of the term 'transversalis fascia' was later extended to "...the entire connective tissue sheet lining the musculature of the (whole) abdominal cavity" by Lampe and others, [92,[95][96][97][98] and this is the most popular definition used in the current surgical practice, [52,88,[99][100][101][102] although various parts of this transversalis fascia are often designated in relation to the respective musculature. [92,103] The bi-laminar description of the Transversalis fascia by Sir Astley Cooper, [31,32,104] has been hotly contested with a number of stalwarts of the field on either side of the debate.…”

Section: Transversalis Fasciamentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

Section: Preperitoneal Fasciamentioning

confidence: 99%

Section: Transversalis Fasciamentioning

confidence: 99%

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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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“…Severe bleeding usually due to vascular injury of iliac vessels and generally occurs because the using of staples during mesh fixation [11]. Patients who undergo laparoscopic herniorraphy have 1.6% incidence of neuralgias due to nerve entrapment during mesh fixation with staples [12]. Some surgeons advocated placing the mesh without fixation in preperitoneal space to avoid nerve injury [13].…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic Inguinal Hernia Repair with Closure of Hernial Defect and Central Mesh Fixation Using Glubran 2

Lasheen¹,

Tolba²,

Mohamed³

et al. 2013

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Background: Laparoscopic tension-free repair of inguinal hernia was presented in 1990s, promising less pain and short recovery period, but carrying the risk mesh bulging and migration. Objective: We have presented our technique in which central zone of mesh is fixed only after closure of hernial defect. Patients and Methods: This study included 27 males patients (14 indirect inguinal hernias, 9 direct inguinal hernias, 4 both direct and indirect inguinal hernias on the same side). These cases are undergoing tension-free mesh repair after closure of hernial defect, and the mesh is fixed only at its central zone using Gulbran 2, between April 2011 and March 2013. The follow-up period ranged from 6 to 30 months. The intra and postoperative complications were recorded. Results: Mean hospital stay was 1 day. The age of this group of patients ranged from 23 to 63 years (mean, 47 years). The operative time ranged from 30 to 100 minutes (mean, 45 minutes). The intraoperative complications were in form of mild bleeding in 7 patients (25.9%) during hernial sac dissection. Postoperative complications were mild inguinal pain in 4 patients (14.8%) for three weeks. Mild hydrocele in 3 patients (11%) was recorded. No recurrence or bulging at hernia site was noticed during the period of follow-up. Conclusion: Laparoscopic inguinal hernia repair with central mesh fixation after closure of hernial defect is effective, easy and free of complications.

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“…This not only ensures the reduction of an obturator hernia, if present, but also provides sufficient preperitoneal space for the placement of a mesh. A sound knowledge of the anatomy of obturator vessels is therefore conducive to the performance of TEP [2].…”

Section: Discussionmentioning

confidence: 99%

A prospective endoscopic study of retropubic vascular anatomy in 121 patients undergoing endoscopic extraperitoneal inguinal hernioplasty

Lau

Lee

2003

Surgical Endoscopy

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Iliopubic vein and artery are universal findings in every patient. Both aberrant obturator artery and vein cross the superior pubic rami, and are therefore susceptible to injuries during dissection of the Bogros space and stapling of the mesh onto Cooper's ligament. Awareness of these aberrant vessels will help to reduce bleeding and subsequent morbidity. Tracing along the aberrant vessel can easily identify the obturator foramen, which is an anatomic landmark that indicates an adequate inferior dissection of the preperitoneal space.

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Surgical Anatomy of the Inguinal Region from a Laparoscopic Perspective

Cited by 6 publications

References 13 publications

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

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

Laparoscopic Inguinal Hernia Repair with Closure of Hernial Defect and Central Mesh Fixation Using Glubran 2

A prospective endoscopic study of retropubic vascular anatomy in 121 patients undergoing endoscopic extraperitoneal inguinal hernioplasty

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