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Moments in Surgical History |

The History of Anatomy and Surgery of the Preperitoneal Space

Petros Mirilas, MD, MSurg; Gene L. Colborn, PhD; David A. McClusky III, MD; Lee J. Skandalakis, MD; Panajiotis N. Skandalakis, MD; John E. Skandalakis, MD, PhD
Arch Surg. 2005;140(1):90-94. doi:10.1001/archsurg.140.1.90.
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Preperitoneal (properitoneal) space is the space between the peritoneum and transversalis fascia. Bogros (1786-1825) described a triangular space in the iliac region between the iliac fascia, transversalis fascia, and parietal peritoneum. In the modern concept, this space lies between the peritoneum and posterior lamina of the transversalis fascia. In 1858, Retzius described the homonymous space, situated anterior and lateral to the urinary bladder (prevesical space). In 1975, Fowler reported that the preperitoneal fascia of the groin is distinct from the transversalis fascia. Preperitoneal herniorrhaphy may be subdivided into 2 approaches: transperitoneal and inguinal. We present herein the evolution of approaches to the preperitoneal space from use of the transperitoneal (or posterior) to use of the anterior preperitoneal and posterior preperitoneal approaches. As anatomic knowledge has increased, the evolution of laparoscopic surgery has paralleled that of open procedures.

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Figure 1.

Representation of the layers of the lower abdominal wall and the inguinal area. 1 indicates the external oblique fascia (fascia of Galaudet); 2, external oblique aponeurosis; 3, internal oblique muscle; 4, transversus abdominis muscle; 5, transversalis fascia anterior; 6, external spermatic fascia; 7, Cooper ligament; 8, pubic bone; 9, pectineus muscle; 10, transversalis fascia; 11, transversalis fascia posterior lamina; 12, vessels; 13, peritoneum; 14, space of Bogros; 15, preperitoneal fat; 16, transversus abdominis aponeurosis and anterior lamina of transversalis fascia; 17, femoral artery; and 18, femoral vein. Reprinted with permission from Skandalakis et al.2

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Figure 2.

Representation of the laparoscopic anatomy of the inguinal area demonstrating layers, fossae, and spaces. Reprinted with permission from Colborn and Skandalakis.3 Copyright 1993, Elsevier Inc.

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