[Relevance of the fascia transversalis in inguinal hernia repair using total extraperitoneal plastic reconstruction]

During total extraperitoneal dissection of inguinal hernias, an artificial preperitoneal cavity is created in the supravesical space by using a balloon dissector. During the operative procedure in vivo and while examining cadavers specially fixated according to the method developed by Thiel in 1992, we investigated the position relative to the balloon the transversalis fascia could be found in and what happened to it during inflation of the balloon. In all cases, the fascia medial to the inferior epigastric arteries was adjacent to the peritoneum and lateral to the abdominal wall. We observed systematic tearing of the fascia along the lateral umbilical plica (inferior epigastric artery). These results suggested that the transversalis fascia could be used only laterally for reinforcement of the dorsal wall of the inguinal canal and/or the support of a mesh used to cover the inguinal floor.