Page 34 - World Journal of Laparoscopic Surgeons

WJOLS

Posterior Rectus Sheath

Graph 2: Distribution of the classical and 11 variant subtypes of PRS-morphology. Observed during TEPP hernioplasty (n = 68) in the different
workers (n = 60); NWT: Normal-length whole-tendinous; SWT: Short whole-tendinous; LWT: Long whole-tendinous; CWT: Complete whole-
tendinous; CMT: Complete musculo-tendinous; NPT: Normal-length partly tendinous; LPT: Long partly-tendinous; CPT: Complete partly-tendinous;
NTO: Normal-length thinned-out; CTO: Complete thinned-out; NGA: Normal-length grossly attenuated; CGA: Complete grossly attenuated;

Graph 3: Correlation between PRS types and occupation; NWT: Normal-length whole-tendinous; SWT: Short whole-tendinous; LWT: Long
whole-tendinous; CWT: Complete whole-tendinous; CMT: Complete musculo-tendinous; NPT: Normal-length partly tendinous; LPT: Long
partly-tendinous; CPT: Complete partly-tendinous; NTO: Normal-length thinned-out; CTO: Complete thinned-out; NGA: Normal-length
grossly attenuated; CGA: Complete grossly attenuated

Clinical Outcome groin dissections documented 43 variations in defects and
musculoaponeurotic insertions of the internal oblique and
All 60 patients successfully underwent 68 TEPP hernio-
plasties (unilateral TEPP 54; bilateral TEPP 8). There was transversus abdominis in the inguinal region.
The PRS in the present study was found neither closely
no conversion due to the difficult dissection secondary applied nor attached/adherent to the undersurface of the
to the so-called adhesions or inflammatory reactions. rectus abdominis muscle. Our observations were in full
There was no recurrence of inguinal hernia after TEPP agreement with those of other authors. 19-21 This anatomic
hernioplasty in the mean follow-up period of 33 ± 17 feature really facilitates the technical feasibility of not only
months (5–61 months).
the rectus sheath technique of the TEPP hernioplasty, but
also the smooth avascular telescopic dissection, obviating
DISCUSSION
the need of the specialized dissecting balloon.
Wide anatomic variations observed in the present study are Classical teaching describes the PRS as incomplete with
in tune with the several previous reports of gross cadaveric formation of the Arcuate line of Douglas at its lower end. 19-
dissections. 3-6,15-18 No report on the live surgical anatomy of 21 However, this anatomic disposition is often lacking, 17,18
the rectus sheath was available in the English literature to and wide variations in the rectus sheath formation have
2
the best of the author’s knowledge. It is interesting to recall been reported from time-to-time. Twelve subtypes of
17
that in 1960, Anson et al in their classic publication on 500 the PRS were documented in various proportions in the
World Journal of Laparoscopic Surgery, January-April 2018;11(1):12-24 21