The anatomical basis for laparoscopic hernia repair revisited

With the development of the transabdominal preperitoneal secured prosthetic mesh repair, many laparoscopic surgeons feel not only that they have a procedure with a low recurrence rate, but that the procedure also has historic academic credibility. This repair emulates well-established open procedures. Shortcomings of this repair include a demand for more precise identification of structures, more careful dissection, and a higher risk of injury to important anatomical entities. There have been anecdotal reports of injuries to nerves such as the lateral femoral cutaneous nerve, the femoral nerve, and the genital branch of the genital-femoral nerve. This article reviews inguinal anatomy from the laparoscopic vantage point and identifies the areas where injury to nerves can occur.