Page 47 - World's Most Popular Laparoscopic Journal

Abhijit Mahanta, RK Mishra

0.5 to 1 cm from its upper margin, thus freeing the hernia important step in the procedure because it allows the free
sac from all visceral and parietal connections. Once the cord to be placed against the posterior wall (Fig. 2). The
peritoneum is incised, it should be lifted bluntly with the prosthesis then lodges perfectly on the inguinofemoral wall,
scissors to allow seeping of the carbon dioxide (CO ) to thus closing the entire pectineal foramen. Next, the ligament
2
assist in peritoneal detachment. Forceps are used to lift the of Cooper is identified by its characteristic consistency and
upper peritoneal margin, while scissors are used to complete greyish-white color, and dissected (Fig. 3). The dissection
peritoneal detachment and inferior epigastric vessel of Cooper’s ligament is performed bluntly with both
dissection. instruments, which are divaricated to free the ligament of
prevesical fat from the pubic symphysis to the external iliac
Parietalization vein. Once the ligament of Cooper has been prepared, the
The pressure of CO entering between the peritoneum and dissection proceeds towards the upper peritoneal flap, which
2
abdominal wall helps dissection and basically requires two is bluntly detached using the scissors or traction with two
instruments: Scissors and 5 mm tissue forceps. The inferior forceps cranially to complete the preparation of inguinal-
peritoneal margin is pulled towards the surgeon with tissue femoral wall.
forceps and bluntly dissected from the spermatic cord,
which is parietalized to obtain an inverted triangle with the Prosthesis Positioning
vas deferens running medially and the genital vessels running Once there is sufficient space for placement of the mesh,
laterally between the iliac vessels in the so-called “triangle the next step is the positioning of prosthesis. Closing of
of disaster.” Parietalization of the spermatic cord is an hernia defect is achieved by means of a nonadsorbable,

A B
Figs 2A and B: Anatomy of hernia

A B
Figs 3A and B: Uscay tissue glue in hernia surgery

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