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Alfredo Moreno-Egea, José Antonio Torralba Martínez, Enrique Girela, Miquel Corral de la Calle, José Luis Aguayo Albasini
Med Sci Monit 2005; 11(3): CR127-131
Background: Laparoscopic surgery provides direct access to the extraperitoneal inguinal space for a clear, amplifi ed view of the anatomical structures. However, the variety of terms used to describe the fascial elements has partly prevented the promulgation of this approach.
Material/Methods: Two hundred patients received surgery for inguinal hernia at an outpatient surgery unit by means of totally extraperitoneal laparoscopy. Regional anatomical dissection was performed during the operation, which was fi lmed for later analysis.
Discussion: The totally extraperitoneal laparoscopic technique is described anatomically, including management of the internal spermatic fascia to create an opening for the use of fenestrated meshes. The technical maneuvers are discussed, with comparison of other possible methods of approach.
Conclusions: From our experience we would recommend: 1) a consensus on terminology is necessary for dissemination of the TEP approach; 2) the ISF must be dissected to avoid ruptures of the sac and ensure parietalization; 3) the “sling of the TF” must be preserved, and 4) the TEP approach does not require dissection medial or inferior to the Cooper ligaments.