Clinical Anatomy of the Groin: Posterior Laparoscopic Approach

Abstract

In-depth knowledge of groin anatomy is essential for a successful inguinal hernia operation. Sir Astley Paston Cooper postulated in 1804, “No disease of the human body, belonging to the province of the surgeon, requires in its treatment, a better combination of accurate, anatomical knowledge with surgical skill than hernia in all its varieties” [1]. While Bassini helped to elucidate the anatomy of the anterior inguinal canal in 1884 [2] ushering in the modern era of safe and effective hernia repair, understanding of the posterior canal remained limited. W.J. Lytle reported in1945, “The operating surgeon knows little of the posterior wall of the inguinal canal, so well is it hidden from his view” [3]. In the early 1990s, laparoscopic approaches to the inguinal canal emerged. However, the posterior anatomy of the groin remained poorly understood and the laparoendoscopic view of this region was virtually unknown to most surgeons [4]. The adoption of this novel and exciting technique without a firm anatomic understanding resulted in several intra- and postoperative complications including vascular, visceral, and nerve injuries as well as high recurrence rates. Detailed study of the posterior anatomy, continuous technical refinements into well-standardized modern laparoscopic techniques, and unparalleled in vivo visualization of this region have transformed laparoscopic inguinal hernia repair into a safe, reproducible, and successful operation providing an ideal repair for all variants of groin hernias.