Laparoscopic Anatomy of the Abdominal Wall

The recent introduction of laparoscopic surgical techniques has challenged the surgeon with a totally new approach to the “problem hernia”: through a laparoscope the hernia is no longer viewed actually as a protrusion from the abdominal wall but rather the extrusion of a viscus from the peritoneal cavity. The layers that constitute the inguinal region and the lower anterior abdominal wall are dissected according to a reversed order and seen from an opposite viewpoint. Indeed, as early as 1945 Lytle wrote: “The operating surgeon knows little of the posterior wall of the inguinal canal, so well it is hidden from his view.” For a safe approach to laparoscopic herniorrhaphy, it would seem appropriate to reverse the habitual order and visualize the anatomy from the inner layers, since laparoscopy provides an optimal panoramic view of the posterior surface of the abdominal wall.