Surgical significance of the arcuate line variations in totally extraperitoneal preperitoneal herniorrhaphy

Objective The aim of this study is to explore the clinical significance of arcuate line variations in totally extraperitoneal preperitoneal herniorrhaphy (TEP). Methods 120 cases of TEP were performed in patients with inguinal hernia in Chashan Hospital Affiliated to Guangdong Medical University between January 2015 and January 2018. The arcuate line was recorded and divided into five groups: traditional group (3 to 5 cm), high level group (less than 2 cm), low level group (6 to 10 cm), and multiple arcuate lines group and absent arcuate line group. Endoscopic vision and ease of procedure were measured by means of visual analogue scale (VAS). Operation time, peritoneal injury, emphysema, hematoma, seroma, infection, chronic pain and recurrence were analyzed. Results The average distance between the umbilicus and the symphysis pubis was 13 cm. The arcuate line was located between 2 to 10 cm below the umbilicus, with 69 cases (57.5%) in the traditional group, 8 cases (6.7%) in high group, 18 cases (15.0%) in low group, and 23 cases (19.2%) in multiple group, and 2 cases (1.7%) in absent group. There was no significant difference in VAS of endo-vision and ease of procedure between the traditional group and the high group (P>0.05). However, there was a significant difference in VAS of endo-vision and ease of procedure between the traditional group and the remaining three groups (low group, multiple group and absent group) (P 0.05). Conclusions The arcuate line in the traditional group accounted for 57.7%, while the arcuate line variations were found in 42.5% of all cases. They not only increased the level of surgical difficulty, but also were associated with higher complications. The hernia surgeon should keenly realize the variations of arcuate line for a successful and safe TEP. Key words: Hernia, inguinal; Herniorrhaphy; Arcuate line