title: Anatomical and surgical study of totally extraperitoneal laparoscopic hernioplasty.
abstract: BACKGROUND
  Laparoscopic surgery provides direct access to the extraperitoneal inguinal space for a clear, amplified view of the anatomical structures. However, the variety of terms used to describe the fascial elements has partly prevented the promulgation of this approach.
  
  
  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 filmed for later analysis.
  
  
  CONCLUSIONS
  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.
authors.affiliation: J M Morales Meseguer University Hospital, Murcia, Spain. moreno-egea@ono.com
authors.forename: Alfredo
authors.initials: A
authors.lastname: Moreno-Egea
authors.forename: José Antonio Torralba
authors.initials: JA
authors.lastname: Martínez
authors.forename: Enrique
authors.initials: E
authors.lastname: Girela
authors.forename: Miquel Corral
authors.initials: MC
authors.lastname: de la Calle
authors.forename: José Luis Aguayo
authors.initials: JL
authors.lastname: Albasini
mesh_terms: D000328:Adult; D000368:Aged; D000556:Ambulatory Surgical Procedures; D005205:Fascia / Q000033:anatomy & histology*; D005260:Female; D006552:Hernia, Inguinal / Q000601:surgery*; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D010044:Outpatient Clinics, Hospital; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D013030:Spain / Q000453:epidemiology; D013526:Surgical Mesh; D009626:Terminology as Topic; D016896:Treatment Outcome