In the Stoppa repair (giant prosthetic reinforcement of the visceral sac), the mesh is placed in which tissue plane?

• A Onlay — superficial to external oblique aponeurosis
• B Preperitoneal space (Retzius and Bogros spaces) — sublay ✓
• C Inlay — within the split internal oblique muscle
• D Intraperitoneal — sutured to peritoneum

Explanation

The Stoppa repair uses a large non-absorbable mesh placed in the preperitoneal space (behind the transversalis fascia, anterior to peritoneum), exploiting the Retzius space medially and Bogros space laterally. Intra-abdominal pressure holds the mesh against the defect — the Pascal principle of repair. It simultaneously addresses bilateral inguinal and femoral hernias without fixation sutures. This is the open preperitoneal precursor of TEP/TAPP.

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

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Written and medically reviewed by the StethoPrep medical team.