c l i n i c a l f o l i o s : n a r r a t i v e





A D V E R T I S E M E N T

 

Hernia Technique Master Class: 40

A D V E R T I S E M E N T

   

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Opening the transversalis fascia exposes the preperitoneal fat layer between transversalis and parietal peritoneum. The transversalis is opened down toward the edge of the rectus sheath, leaving a 1cm strip of iliopubic tract adjacent to the inguinal ligament. When the transversalis is open, the surgeon should feel the upper end of the femoral canal between the lacunar ligament and the external iliac vein to rule out femoral hernia.    

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Hernia Technique Master Class: 41

A D V E R T I S E M E N T

   

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The edge of the cephalad flap of transversalis at the deep ring is grasped with a hemostat and the transversalis is peeled cephalad, pushing away the preperitoneal fat from its deep surface.     

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Hernia Technique Master Class: 42

A D V E R T I S E M E N T

   

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On the underside of the cephalad flap, the firm white transversus arch/falx can be seen through the transversalis fascia. Any attenuated central area of transversalis is excised, leaving only the strong portion adjacent to the falx.     

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This page was last modified on 2/10/2009.