The preperitoneal approach to the groin and the inferior epigastric vessels

Abstract

Preperitoneal, a word coined by Nyhus in the 1960s, has been applied not only to posterior approaches that he, Stoppa, and Wantz popularized but to anterior exposures of the groin, which divide the transversalis fascia. This assumes that all give similar views of the easily cleaved space of Bogros. However, accumulated anatomical observations reveal the transversalis fascia as having not one but two layers. The inferior epigastric vessels run between rather than in the preperitoneal space, which is avascular and has its own fascia lining the peritoneum. Historical evidence shows that both the midline Cheatle-Henry and lateral Ugahary-Kugel approaches, which transect the abdominal wall, provide excellent exposure of the avascular preperitoneal space. However, neither the unilateral posterior McEvedy approach nor the anterior approach does, as only part of the musculature and fasciae are retracted. The inferior epigastric vasculature and posterior lamina transversalis fascia, which remain in situ, block the view. Unless they are disrupted or circumvented, neither of the latter approaches or subsequent repairs should be labeled preperitoneal.