Selected Further Reading |
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Franklin ME Jr, Dorman JP, Pharand D (1994) Laparoscopic surgery in acute small bowel obstruction. Surg Laparosc Endosc 4(4):289–296
Gandhi AD, Patel RA, Brolin RE (2009) Elective laparoscopy for herald symptoms of mesenteric/internal hernia after laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis 5(2):144–149
Greig JD, Miles WF, Nixon SI (1995) Laparoscopic technique for small bowel biopsy. Br J Surg 82(3):363
Husain S, Ahmed AR, Johnson J, Boss T, O’Malley W (2007) Small-bowel obstruction after laparoscopic Roux-en-Y gastric bypass: etiology, diagnosis, and management. Arch Surg 142(10):988–993
Lange V, Meyer G, Schardey HM et al (1995) Different techniques of laparoscopic end-to- end small-bowel anastomoses. Surg Endosc 9(1):82–87
Lee IK, Kim do H, Gorden DL, Lee YS, Jung SE, Oh ST, Kim JG, Jeon HM, Kim EK, Chang SK (2009) Selective laparoscopic management of adhesive small bowel obstruction using CT guidance. Am Surg 75(3):227–231
Nagle A, Ujiki M, Denham W, Murayama K (2004) Laparoscopic adhesiolysis for small bowel obstruction. Am J Surg 187(4):464–470
Posta C (1996) Surgical decisions in the laparoscopic management of small bowel obstruction: report on two cases. J Laparoendosc Surg 6(2):117–120
Slutzki S, Halpern Z, Negri M, Kais H, Halevy A (1996) The laparoscopic second look for ischemic bowel disease. Surg Endosc 10(7):729–731
Waninger I, Salm R, Imdahl A et al (1996) Comparison of laparoscopic handsewn suture techniques for experimental small-bowel anastomoses. Surg Laparosc Endosc 6(4):282–289
Yau KK, Siu WT, Law BK, Cheung HY, Ha JP, Li MK (2005) Laparoscopic approach compared with conventional open approach for bezoar-induced small-bowel obstruction. Arch Surg 140(10):972–975
Zerey M, Sechrist CW, Kercher KW, Sing RF, Matthews BD, Heniford BT (2007) The laparoscopic management of small-bowel obstruction. Am J Surg 194(6):882–887
Selected
Further
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Inguinal Hernia 10
Repair
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The understanding and recognition of the anatomy of the preperitoneal space is |
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Considerations |
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essential to the performance of a safe and effective laparoscopic hernia repair (Fig. 10.1). |
and Surgical |
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The five important landmarks are as follows: |
Anatomy |
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Pubic tubercle and Cooper’s ligament. |
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External iliac vein. |
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Medial umbilical ligament and the inferior epigastric vessels as they come off the |
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external iliac vessels. |
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Vas deferens. |
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Cord vessels. |
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Along with the iliopubic tract, these landmarks define the three spaces associated with groin hernias (Fig. 10.2):
1.Indirect inguinal hernia: lateral to the inferior epigastric vessels.
2.Direct inguinal hernia: medial to the inferior epigastric vessels and lateral to the border of the rectus abdominus muscle within the triangle of Hesselbach.
3.Femoral hernia: under the iliopubic tract, medial to the iliac vein, and lateral to Cooper’s ligament.
All three spaces should be covered by an appropriate size mesh. They are no different from the hernia spaces seen in the traditional open anterior approach (Fig. 10.3).
There are several dangerous areas of dissection with the laparoscopic repair. The “triangle of doom” is located between the vas deferens medially and the gonadal vessels
N. Katkhouda, Advanced Laparoscopic Surgery,
DOI: 10.1007/978-3-540-74843-4_10, © Springer-Verlag Berlin Heidelberg 2011
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Chapter 10 Inguinal Hernia Repair |
Fig. 10.1 Anatomy of the preperitoneal space (right side)
Fig. 10.2 Hernia spaces
General Considerations and Surgical Anatomy |
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Fig. 10.3 Hernia spaces as seen from the anterior approach
laterally. The external iliac vein and artery are found in this triangle. There is another dangerous space at the superior aspect of the internal ring where the genital branch of the genitofemoral nerve enters the spermatic cord (Fig. 10.4). It is hazardous to apply electrocautery in this area because of the risk of injury to the nerve. Electrocautery is usually applied when raising the peritoneal flap at the beginning of the transabdominal preperitoneal operation, and the dissection should start 1 cm above the internal ring.
There is another dangerous zone inferior to the iliopubic tract and lateral to the gonadal vessels, the “triangle of pain,” where one can find the genitofemoral and lateral femoral cutaneous nerves.Stapling in this area may injure either of these nerves.Together, the area between the vas deferens medially and the iliopubic tract superiorly and laterally constitutes “the square of doom,” where staples or electrocautery should NEVER be applied to avoid irreversible nerve injury (Fig. 10.5).
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Chapter 10 Inguinal Hernia Repair |
Fig. 10.4 Lateral nerves of the groin
Fig. 10.5 Square of doom, delineated by the vas deferens medially and the inguinal ligament lateral and superiorly