In totally extraperitoneal (TEP) laparoscopic inguinal hernia repair, which anatomical space is developed by balloon dissection to allow mesh placement?

• A Intraperitoneal space anterior to the bladder
• B Preperitoneal space (Retzius space and space of Bogros) ✓
• C Retroperitoneal space lateral to the aorta
• D Subfascial space beneath transversalis fascia only

Explanation

TEP repair develops the preperitoneal space (Retzius space medially and space of Bogros laterally) anterior to the peritoneum and posterior to the transversalis fascia using balloon dissection through a periumbilical incision. The mesh is placed in this extraperitoneal plane covering the myopectineal orifice of Fruchaud without entering the peritoneal cavity. This differs from TAPP (transabdominal preperitoneal) repair, which enters the peritoneum before developing the same space. Staying entirely extraperitoneal reduces bowel adhesion risk.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.