The Preperitoneal Space in Hernia Repair

Abstract

The preperitoneal spaces relevant for incisional hernia repair and minimally invasive groin hernia repair are described in terms of surgical anatomy. Emphasis is put on the transversalis fascia and the urogenital fascia and its extensions, the vesicoumbilical fascia, and the spermatic sheath of Stoppa procedure. Steps in hernia surgery where these structures are relevant are reviewed.

Key Questions

What is the significance of the preperitoneal space in hernia repair?

The preperitoneal space is crucial in hernia repair as it allows surgeons to access and reinforce the abdominal wall without entering the peritoneal cavity. This approach minimizes the risk of intra-abdominal complications and provides a more anatomical repair by placing mesh in a location that counteracts hernia formation effectively.

How is the transversalis fascia involved in hernia surgery?

The transversalis fascia plays a pivotal role in hernia surgery, serving as a landmark and a structural layer that surgeons must navigate. Understanding its anatomy is essential for procedures like the Stoppa repair, where the fascia's integrity and positioning influence the placement of prosthetic materials and the overall success of the surgery.

What are the spaces of Bogros and Retzius, and why are they important?

The spaces of Bogros and Retzius are anatomical areas within the preperitoneal space. The space of Bogros lies lateral to the bladder, while the space of Retzius is located behind the pubic bone. These spaces are significant because they provide pathways for surgical access during hernia repairs, allowing for the placement of mesh and other materials without breaching the peritoneal cavity.

How does the understanding of urogenital fascia contribute to surgical outcomes?

A thorough comprehension of the urogenital fascia and its extensions, such as the vesicoumbilical fascia, is vital for surgeons. This knowledge aids in avoiding injuries to vital structures during dissection and ensures the correct placement of surgical materials, thereby enhancing the safety and efficacy of hernia repairs.