๐—ง๐—ต๐—ฒ ๐˜€๐—ฝ๐—ฎ๐—ฐ๐—ฒ ๐—ผ๐—ณ ๐—•๐—ผ๐—ด๐—ฟ๐—ผ๐˜€

๐—ง๐—ต๐—ฒ ๐˜€๐—ฝ๐—ฎ๐—ฐ๐—ฒ ๐—ผ๐—ณ ๐—•๐—ผ๐—ด๐—ฟ๐—ผ๐˜€:

(Also called retroinguinal space or Espace de Bogros, Named by Rouviere in 1912)

It is an extraperitoneal space situated deep to the inguinal ligament.

Itโ€™s limited by the fascia transversalis anteriorly, the peritoneum posteriorly and the iliac fascia (pelvic wall) laterally

This preperitoneal space communicates with prevesical space of Retzius (๐˜„๐—ต๐—ถ๐—ฐ๐—ต ๐—ถ๐˜€ ๐—ฝ๐—ฟ๐—ฒ๐˜€๐—ฒ๐—ป๐˜ ๐—บ๐—ฒ๐—ฑ๐—ถ๐—ฎ๐—น ๐˜๐—ผ ๐—•๐—ผ๐—ด๐—ฟ๐—ผ๐˜€ ๐˜€๐—ฝ๐—ฎ๐—ฐ๐—ฒ).

It is divided into two compartments.

The ๐—บ๐—ฒ๐—ฑ๐—ถ๐—ฎ๐—น compartment contains vasculature including the femoral artery and vein.

The ๐—น๐—ฎ๐˜๐—ฒ๐—ฟ๐—ฎ๐—น compartment allows for passage of the illiopsoas (primary hip flexor), allowing attachment to the femur, along with the femoral nerve.

-๐—ฆ๐˜๐—ผ๐—ฝ๐—ฝ๐—ฎ claim that the Bogrosโ€™ space is further divided into a ๐˜€๐˜‚๐—ฝ๐—ฒ๐—ฟ๐—ณ๐—ถ๐—ฐ๐—ถ๐—ฎ๐—น and ๐—ฑ๐—ฒ๐—ฒ๐—ฝ space by the spermatic sheath, the former containing the external iliac artery and nerve, while the latter is avascular where is the recommended placement of a large retroparietal (preperitoneal) mesh prosthesis (Fig. 2.31)

-๐—•๐—ฒ๐—ป๐—ฑ๐—ฎ๐˜ƒ๐—ถ๐—ฑ (1992) reported that the space of Bogros is a lateral extension of the space of Retzius posterior to the inguinal canal, and contains a venous circle formed by the deep inferior gastric vein, iliopibic vein, rectusial vein, suprapubic vein, and retropubic vein.

๐—–๐—น๐—ถ๐—ป๐—ถ๐—ฐ๐—ฎ๐—น ๐—ถ๐—บ๐—ฝ๐—ผ๐—ฟ๐˜๐—ฎ๐—ป๐—ฐ๐—ฒ:

๐Ÿ…๏ธŽThese are holy planes of dissections in both TEP & TAPP.

๐Ÿ…‘๏ธŽBoth (๐—•๐—ผ๐—ด๐—ฟ๐—ผ๐˜€ & ๐—ฅ๐—ฒ๐˜๐˜‡๐—ถ๐˜‚๐˜€) form the site of surgery in Total extraperitoneal repair (๐—ง๐—˜๐—ฃ) of inguinal hernia.

๐Ÿ…’๏ธŽDuring laparoscopic inguinal hernia repair, the space of Bogros is explored to access the iliac fossa as well as to make it easier to open the lateral mesh and lay it flat.

๐Ÿ…“๏ธŽSome problems encountered at re-operation following repair of groin hernia with pre-peritoneal prostheses.

๐—ฆ๐—ฝ๐—ฎ๐—ฐ๐—ฒ ๐—ผ๐—ณ ๐—ฅ๐—ฒ๐˜๐˜‡๐—ถ๐˜‚๐˜€:

-Also called Retropubic space, Prevesical space or cave of Retzius.

-It is an extraperitoneal space located posterior to the pubic symphysis and anterior to the urinary bladder.

-It is a loose space with allows the bladder to fill and empty and there are no obvious blood vessels. The space is easily separated.

-It is separated from the anterior abdominal wall by the transversalis fascia and extends to the level of the umbilicus.

๐—–๐—ผ๐—ป๐—ฐ๐—น๐˜‚๐˜€๐—ถ๐—ผ๐—ป:

The preperitoneal surgical dissection was avascular and straightforward as long as both fascia & fat was visible on both sides of the dissection planeโ€“anteriorly the diaphanous transversalis fascia and posteriorly the preperitoneal fascia covering the preperitoneal fat, and this loose easily fissile avascular plane between the transversalis fascia and preperitoneal fascia was labelled as the โ€˜surgical preperitoneal spaceโ€™ to differentiate it from the true preperitoneal space. The requisite holy plane of โ€˜surgical preperitoneal spaceโ€™ conformed fully to the Bogros concept of the preperitoneal space. In addition to the technical learning and handsโ€“on training, it is binding on the part of surgeon to acquire accurate flawless knowledge of the complex inguinal multifascial anatomy before performing the technically demanding laparoscopic hernioplasty, because the seamless preperitoneal repair of inguinal repair needs mastery of preperitoneal anatomy to satisfy the Stoppaโ€™s basic two principles of preperitoneal repair, namely, timely identification of a bloodless plane in the interparietoโ€“peritoneal space, and adequate parietalization of the cord structures.