Surgical anatomy of the preperitoneal fasciae and posterior transversalis fasciae in the inguinal region

Until the relatively recent interest in laparoscopic preperitoneal hernia repairs, most Surgeons in the United States and in many other countries performed open anterior repairs. There was little reason to study the preperitoneal anatomy. Surgeons involved with laparoscopic and open preperitoneal hernia repairs work in the preperitoneal fascial planes and transversalis fascia that has not been well described in the current English literature. We have carefuly studied the preperitoneal fasciae and posterior rectus sheath using the excellent perspective, lighting and magnification afforded by the laparoscopic approach. The preperitoneal fascias are distinct from the transversalis fascia with a separate blood supply. The transversalis fascia in the inguinal space is likely related to the posterior rectus fascia. We attempt to clarify the anatomy of the fasciae in this area with laparoscopic photographs and validate our observations with review of the literature and selected illustrations taken from anatomical texts.