𝗧𝗵𝗲 𝘀𝗽𝗮𝗰𝗲 𝗼𝗳 𝗕𝗼𝗴𝗿𝗼𝘀:
(Also called retroinguinal space or Espace de Bogros, Named by Rouviere in 1912)
It is an extraperitoneal space situated deep to the inguinal ligament.
It’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 (𝘄𝗵𝗶𝗰𝗵 𝗶𝘀 𝗽𝗿𝗲𝘀𝗲𝗻𝘁 𝗺𝗲𝗱𝗶𝗮𝗹 𝘁𝗼 𝗕𝗼𝗴𝗿𝗼𝘀 𝘀𝗽𝗮𝗰𝗲).
It is divided into two compartments.
The 𝗺𝗲𝗱𝗶𝗮𝗹 compartment contains vasculature including the femoral artery and vein.
The 𝗹𝗮𝘁𝗲𝗿𝗮𝗹 compartment allows for passage of the illiopsoas (primary hip flexor), allowing attachment to the femur, along with the femoral nerve.
-𝗦𝘁𝗼𝗽𝗽𝗮 claim that the Bogros’ space is further divided into a 𝘀𝘂𝗽𝗲𝗿𝗳𝗶𝗰𝗶𝗮𝗹 and 𝗱𝗲𝗲𝗽 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)
-𝗕𝗲𝗻𝗱𝗮𝘃𝗶𝗱 (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.
🅐︎These are holy planes of dissections in both TEP & TAPP.
🅑︎Both (𝗕𝗼𝗴𝗿𝗼𝘀 & 𝗥𝗲𝘁𝘇𝗶𝘂𝘀) form the site of surgery in Total extraperitoneal repair (𝗧𝗘𝗣) of inguinal hernia.
🅒︎During 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.
🅓︎Some problems encountered at re-operation following repair of groin hernia with pre-peritoneal prostheses.
𝗦𝗽𝗮𝗰𝗲 𝗼𝗳 𝗥𝗲𝘁𝘇𝗶𝘂𝘀:
-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.
The preperitoneal surgical dissection was avascular and straightforward as long as both fascia & fat was visible on both sides of the dissection plane–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 ‘surgical preperitoneal space’ to differentiate it from the true preperitoneal space. The requisite holy plane of ‘surgical preperitoneal space’ conformed fully to the Bogros concept of the preperitoneal space. In addition to the technical learning and hands–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 Stoppa’s basic two principles of preperitoneal repair, namely, timely identification of a bloodless plane in the interparieto–peritoneal space, and adequate parietalization of the cord structures.