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Paradigm shift regarding the transversalis fascia, preperitoneal space, and Retzius’ space

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A Comment to this article was published on 19 May 2018

Abstract

Background

There has been confusion in the anatomical recognition when performing inguinal hernia operations in Japan. From now on, a paradigm shift from the concept of two-dimensional layer structure to the three-dimensional space recognition is necessary to promote an understanding of anatomy.

Anatomy and Embryology

Along with the formation of the abdominal wall, the extraperitoneal space is formed by the transversalis fascia and preperitoneal space. The transversalis fascia is a somatic vascular fascia originating from an arteriovenous fascia. It is a dense areolar tissue layer at the outermost of the extraperitoneal space that runs under the diaphragm and widely lines the body wall muscle. The umbilical funiculus is taken into the abdominal wall and transformed into the preperitoneal space that is a local three-dimensional cavity enveloping preperitoneal fasciae composed of the renal fascia, vesicohypogastric fascia, and testiculoeferential fascia. The Retzius’ space is an artificial cavity formed at the boundary between the transversalis fascia and preperitoneal space. In the underlay mesh repair, the mesh expands in the range spanning across the Retzius’ space and preperitoneal space.

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Authors and Affiliations

  1. Department of Surgery, Tsudanuma Central General Hospital, 1-9-17 Yatsu, Narashino-shi, Chiba, 275-0026, Japan

    N. Asakage

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  1. N. Asakage
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Correspondence to N. Asakage.

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N. A declares no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the insitutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Asakage, N. Paradigm shift regarding the transversalis fascia, preperitoneal space, and Retzius’ space. Hernia 22, 499–506 (2018). https://doi.org/10.1007/s10029-018-1746-8

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  • DOI: https://doi.org/10.1007/s10029-018-1746-8

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