关键词: 腹股沟疝, 腹腔镜, 经腹腹膜前, 全腹膜外, 关键技术

Abstract: Standards and evaluations of key techniques in laparoscopic inguinal hernia surgery        LI Jian-wen, YUE Fei, XUE Pei. Department of General Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
Corresponding author：LI Jian-wen:E-mail:ljw5@yeah.net
Abstract    Establishing surgical space，managing the hernia sac and flattening of mesh are the most critical steps in laparoscopic inguinal hernia repair（LIHR）.Once the peritoneum is opened in transabdominal preperitoneal（TAPP）repair，the natural expansion of the pneumoperitoneum would help to enter the ideal plane.Totally extraperitoneal（TEP）repair requires specific techniques to enter the parietal or visceral plane via retromuscular space.Plane transition in different areas helps to reach the correct plane.The parietal plane is the holy plane of TEP，however，the reduction of indirect hernias could only be accomplished on the visceral plane.The dissection of direct hernia can be seen as the separation of the transversalis fascia（TF）and the preperitoneal fascia（PPF）.The hernia sac is easy to reduce and should not be transected.The reduction of the hernia sac of indirect hernia involves the separation of the peritoneum and the spermatic cord components，which is difficult to perform.Small hernia sacs should be reduced completely，and large ones could be transected at a high position.The mesh should cover the myopectineal orifice and maintain sufficient overlap with the surrounding tissue.After dissecting the preperitoneal loop，the mesh could be flattened in the connected parietal and visceral plane.Mechanical or penetrating fixation of mesh is seldom required in LIHR.

Key words: inguinal hernia, laparoscopic, transabdominal preperitoneal, totally extraperitoneal, key technique