THE RELEVANCE OF THE FASCIA TRANSVERSALIS FOR INGUINAL-HERNIA REPAIR USING TOTAL EXTRAPERITONEAL DISSECTION

During total extraperitoneal dissection of inguinal hernias, an artifi cial preperitoneal cavity is created in the supravesical space by usin g a balloon dissector. During the operative procedure in vivo and whil e examining cadavers specially fixated according to the method develop ed by Thiel in 1992, we investigated the position relative to the ball oon the transversalis fascia could be found in and what happened to it during inflation of the balloon. In all cases, the fascia medial to t he inferior epigastric arteries was adjacent to the peritoneum and lat eral to the abdominal wall. We observed systematic tearing of the fasc ia along the lateral umbilical plica (inferior epigastric artery). The se results suggested that the transversalis fascia could be used only laterally for reinforcement of the dorsal wall of the inguinal canal a nd/or the support of a mesh used to cover the inguinal floor.