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Posterior Component Separation
Published in Jeff Garner, Dominic Slade, Manual of Complex Abdominal Wall Reconstruction, 2020
If considering a ‘bottom-up’ TAR approach, the dissection starts in the pelvis with careful sweeping of the peritoneum away from the bladder and pubic symphysis anteriorly; Cooper's ligaments are identified and anchoring sutures placed. The dissection now continues laterally sweeping the peritoneum away from the lateral walls and associated fat. The spermatic cord or round ligaments are dissected free and the peritoneum swept away up to the arcuate line. At this point there is a potential retro-inguinal space (of Bogros) beneath the arcuate line and lateral to the peritoneum when swept medially (Figure 12.9).
Achieving the Learning Curve in Laparoscopic Inguinal Hernia Repair by Tapp: A Quality Improvement Study
Published in Journal of Investigative Surgery, 2019
Umberto Bracale, Giovanni Merola, Antonio Sciuto, Giuseppe Cavallaro, Jacopo Andreuccetti, Giusto Pignata
Pneumoperitoneum is established with a Veress technique.14 The first 10 mm trocar is placed in the umbilicus and two other 5 mm ports are placed bilaterally in the midclavicular line 1 cm below the transverse umbilical line. After identification of anatomical landmarks (Epigastric Vessels, Spermatic vessels, vas deferens or round ligament, urachus, iliac vessels and bladder) and evaluation of all defects according to EHS classification,11 the preperitoneal space is opened incising the peritoneum transversely from the region of the umbilical artery laterally to the hernia defect. Dissection is made in the Retzius and Bogros (retroinguinal) spaces. Anatomical landmarks (epigastric vessels, Cooper and Gimbernat ligaments, the corona mortis and external iliac vessels) are then identified and well exposed. The sac dissection is carried out, carefully safeguarding the spermatic fascia, and protecting the fragile parietal structures. A complete peritoneal dissection of the medial compartment as well as of the peritoneum is then carried out.