腹腔镜全腹膜外肌后修补术治疗腹壁切口疝的解剖特点和技术要点OA

Endoscopic totally extraperitoneal retromuscular repair represents an emerging minimally invasive approach for ventral and incisional hernia,adhering to the dual principles of plane-oriented dissection and minimally invasion.Enhanced-view totally extraperitoneal repair is currently the most widely accepted nomenclature.The core concept of this technique lies in achieving continuity of the retromuscular and extraperitoneal space under an optimized endoscopic enhanced-vision.A comprehensive understanding of surgical approaches and anatomical planes is fundamental to procedural success.Commonly adopted approaches include the midline,lateral,and ipsilateral approach,while the surgical planes could be categorized into the pre-sheath plane and the retro-sheath plane.The pre-sheath plane contains multiple tendinous intersections and aponeurotic partitions;therefore,meticulous anatomical dissection is required to balance adequate exposure,avoidance of excessive dissection,and restoration of anatomical structure,thereby preserving the biomechanical stability of the abdominal wall.In contrast,the retro-sheath plane lacks tendinous structures but encompasses areas of fascial convergence where tissue layers are thin and closely adherent,conferring a higher risk of peritoneal injury and directly influencing operative success rates.