Summary
Stoppa introduced giant preperitoneal mesh repair after parietalisation of the cord in inguinal hernias. Based on this principle, a preperitoneal mesh is inserted during the laparoscopic transabdominal preperitoneal (TAPP) repair. Central to the Stoppa operation is identification of the bloodless plane between peritoneum and urogenital fascia. Dissection of this plane has not been described for the TAPP hernia repair. We present a reproducible, anatomicallybased method of finding and dissecting the urogenital fascia in the TAPP.
Methods: After routine peritoneal incision, the urogenital fascia is identified late-rally in the Bogros space, where it is loosely adherent to the peritoneum. Here, developing the cleavage plane between the fascia and peritoneum is easy. The dissection is extended medially into the space of Retzius. Once the medial and lateral planes have been dissected, reducing the hernia sac is uncomplicated and bloodless. Because the urogenital fascia continues around the cord structures as the spermatic sheath, there is no danger of damaging these and it is easy to parietalise the vas deferens and testicular vessels. The mesh is then inserted true to the original dictates of Stoppa.
Discussion: The precise preperitoneal dissection plane has not been elucidated for laparoscopy. The fascial anatomy in the groin is a complex arrangement between peritoneum, urogenital fascia and transversalis fascia. Dissection between the correct fascial layers allows rapid identification of the exact anatomy in an avascular plane. This ensures true parietalisation of the cord structures in an ordered and anatomically correct fashion.
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Fölscher, D.J., Leroy, J., Jamali, F.R. et al. Totally extrafasdal endoscopie preperitoneal hernia repair: a merger of anatomy and surgery. The exact description to endoscopkally dissect the spermatic fascia. Hernia 4, 223–227 (2000). https://doi.org/10.1007/BF01201071
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DOI: https://doi.org/10.1007/BF01201071