๐ง๐ต๐ฒ ๐๐ฝ๐ฎ๐ฐ๐ฒ ๐ผ๐ณ ๐๐ผ๐ด๐ฟ๐ผ๐:
(Also called retroinguinal space or Espace de Bogros, Named by Rouviere in 1912)
It is an extraperitoneal space situated deep to the inguinal ligament.
Itโs 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 (๐๐ต๐ถ๐ฐ๐ต ๐ถ๐ ๐ฝ๐ฟ๐ฒ๐๐ฒ๐ป๐ ๐บ๐ฒ๐ฑ๐ถ๐ฎ๐น ๐๐ผ ๐๐ผ๐ด๐ฟ๐ผ๐ ๐๐ฝ๐ฎ๐ฐ๐ฒ).
It is divided into two compartments.
The ๐บ๐ฒ๐ฑ๐ถ๐ฎ๐น compartment contains vasculature including the femoral artery and vein.
The ๐น๐ฎ๐๐ฒ๐ฟ๐ฎ๐น compartment allows for passage of the illiopsoas (primary hip flexor), allowing attachment to the femur, along with the femoral nerve.
-๐ฆ๐๐ผ๐ฝ๐ฝ๐ฎ claim that the Bogrosโ space is further divided into a ๐๐๐ฝ๐ฒ๐ฟ๐ณ๐ถ๐ฐ๐ถ๐ฎ๐น and ๐ฑ๐ฒ๐ฒ๐ฝ 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)
-๐๐ฒ๐ป๐ฑ๐ฎ๐๐ถ๐ฑ (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.
๐๐น๐ถ๐ป๐ถ๐ฐ๐ฎ๐น ๐ถ๐บ๐ฝ๐ผ๐ฟ๐๐ฎ๐ป๐ฐ๐ฒ:
๐ ๏ธThese are holy planes of dissections in both TEP & TAPP.
๐ ๏ธBoth (๐๐ผ๐ด๐ฟ๐ผ๐ & ๐ฅ๐ฒ๐๐๐ถ๐๐) form the site of surgery in Total extraperitoneal repair (๐ง๐๐ฃ) of inguinal hernia.
๐ ๏ธDuring 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.
๐ ๏ธSome problems encountered at re-operation following repair of groin hernia with pre-peritoneal prostheses.
๐ฆ๐ฝ๐ฎ๐ฐ๐ฒ ๐ผ๐ณ ๐ฅ๐ฒ๐๐๐ถ๐๐:
-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.
๐๐ผ๐ป๐ฐ๐น๐๐๐ถ๐ผ๐ป:
The preperitoneal surgical dissection was avascular and straightforward as long as both fascia & fat was visible on both sides of the dissection planeโanteriorly 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 โsurgical preperitoneal spaceโ to differentiate it from the true preperitoneal space. The requisite holy plane of โsurgical preperitoneal spaceโ conformed fully to the Bogros concept of the preperitoneal space. In addition to the technical learning and handsโon 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 Stoppaโs basic two principles of preperitoneal repair, namely, timely identification of a bloodless plane in the interparietoโperitoneal space, and adequate parietalization of the cord structures.