TY - CHAP M1 - Book, Section TI - Laparoscopic Anatomy of the Inguinal Region A1 - Ellison, E. Christopher A1 - Zollinger, Jr., Robert M. A1 - Pawlik, Timothy M. A1 - Vaccaro, Patrick S. A1 - Bitans, Marita A1 - Baker, Anthony S. PY - 2022 T2 - Zollinger’s Atlas of Surgical Operations, 11e AB - This chapter shows the key anatomic features of importance that a skilled surgeon must know thoroughly during any type of laparoscopic operation for inguinal and femoral hernia repair. The first concept is to recognize that the parietal peritoneum covers certain structures forming five ligaments that are useful landmarks in identifying the hernia spaces when approaching the groin from the intraperitoneal route as in the transabdominal preperitoneal repair. These ligaments include the median umbilical ligament (1) running from the bladder to the umbilicus; the medial umbilical ligaments (3), which are the remnants of the obliterated umbilical arteries; and the lateral umbilical ligaments (4) formed by the peritoneum covering the inferior epigastric vessels (13). The spatial relationships of these ligaments allow recognition of the various types of hernias. A direct inguinal hernia (19) occurs in the medial space bounded by the inferior epigastric vessels or lateral umbilical ligament, the iliopubic tract (21), and the rectus muscle. An indirect inguinal hernia presents through the internal ring (18) above the iliopubic tract and is lateral to the lateral umbilical ligament containing the epigastric vessels (13) on the posterior surface of the rectus muscle (2). The femoral hernia space (20) can be seen below the iliopubic tract (21) and medial to the femoral vessels exiting through the femoral canal. During laparoscopic repair, the direct, indirect, and femoral spaces all should be covered with mesh. SN - PB - McGraw-Hill Education CY - New York, NY Y2 - 2024/03/28 UR - accesssurgery.mhmedical.com/content.aspx?aid=1187823200 ER -