Intraoperative Observation during Total Extraperitoneal Repair (TEP).
Am Surg
; 86(2): 146-151, 2020 Feb 01.
Article
em En
| MEDLINE
| ID: mdl-32106908
ABSTRACT
We aim to observe and dissect the essential anatomical landmarks in totally extraperitoneal (TEP) procedures. Forty-six TEP procedures in 30 patients were prospectively performed in our department. During the dissection of the preperitoneal space, the following distances between landmarks were measured. D1 the distance from pubic symphysis to the arcuate line in the midline; D2 the distance from the inferior epigastric artery to the lateral border of the arcuate line (before sharp incision was performed); D3 as in D2 (but after sharp incision was performed); D4 the distance from the inferior epigastric artery to the crossing site of vas deferens and obliterated umbilical artery. Furthermore, the morphology of the posterior rectus sheath was documented. The corresponding distance between the anatomical landmarks varied greatly in each individual. D1 8 ± 1.6 cm (range 4-10 cm). D2 4.9 ± 0.8 cm (3.5-7 cm). D3 6.8 ± 0.9 cm (5-9 cm). D4 6.1 ± 1 cm (4.8-8.5 cm). Complete rectus sheath was found in 30.4 per cent (14/46) of the hernias. Anatomical variations were common in preperitoneal space. The crossing site of vas deferens and obliterated umbilical artery can serve as a landmark for dissection. Complete rectus was present in one-third of hernias, which necessitates a sharp incision for entering the correct lateral preperitoneal space.
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Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Endoscopia
/
Pontos de Referência Anatômicos
/
Herniorrafia
/
Hérnia Inguinal
Tipo de estudo:
Observational_studies
Limite:
Humans
/
Male
Idioma:
En
Revista:
Am Surg
Ano de publicação:
2020
Tipo de documento:
Article