Which landmarks are used in a transabdominal preperitoneal (TAPP) laparoscopic inguinal hernia repair?

Updated: Apr 16, 2020
  • Author: Danny A Sherwinter, MD; Chief Editor: Kurt E Roberts, MD  more...
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Answer

Transabdominal laparoscopic landmarks useful when performing the TAPP repair are the obliterated fetal remnants, which divide the posterior surface of the anterior abdominal wall into three fossae as follows [56] :

  • The median umbilical ligament is a remnant of the embryonic urachus; it forms the center divide by arising in the midline from the apex of the bladder toward the umbilicus
  • Laterally, the paired medial umbilical ligaments, vestiges of the fetal umbilical arteries, arise from the superior vesicle arteries toward the umbilicus
  • Between the median and medial ligaments lie the supravesical fossae, where external supravesical hernias occur
  • Most lateral are the paired lateral umbilical ligaments, which contain the inferior epigastric arteries; between them and the medial ligaments lies the medial fossa, which contains the Hesselbach triangle (the zone of direct hernias), and lateral to the inferior epigastric arteries is the lateral fossa (the site of indirect hernias); thus, the lateral umbilical ligaments separate the lateral and medial fossae and differentiate indirect from direct hernias

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