Endoscopic totally visceral sac separation: a novel concept for ventral hernia

Abstract

The whole abdominal wall can be regarded as a physiological and functional entity which is composed of multiple anatomical structures and layers. Surgical approaches or techniques are differently required for different portions of the abdominal wall. Indeed, the abdominal wall is confined by several anatomical boundaries which make different surgical spaces disconnected. If these boundaries could be broken down, separated spaces are now connected, establishing an ample retromuscular/preperitoneal space to perform totally visceral sac separation. The author has investigated the anatomical portions, significance of abdominal wall in totally visceral sac separation, and technical details and notes of totally visceral sac separation for different portions of abdominal wall in this paper. Key words: Hernia; Ventral hernia; Endoscopy; Totally visceral sac separation; Tension free repair; Extraperitoneal; Retromuscular repair; Laparoscopy