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Concept: Transversalis fascia


The aim of the study was to assess the effectiveness of ultrasound-guided transversalis fascia plane block (TFP) compared to anterior transversus abdominis plane block (TAP-A) for post-operative analgesia in outpatient unilateral inguinal hernia repair.

Concepts: Inguinal hernia, Transversus abdominis muscle, Iliac crest, Transversalis fascia


The transversalis fascia plane and the quadratus lomborum blocks target the branches of T12-L1 nerves and provide analgesia in patients undergoing surgery involving the corresponding dermatomes. The transversalis fascia is believed to contribute to determine the spread of local anesthetic in such blocks. Nonetheless, the anatomy of this fascia and its possible role in these blocks still have to be precisely defined.

Concepts: Physician, Anesthesia, Local anesthesia, Local anesthetic, Transversalis fascia


There has been confusion in the anatomical recognition when performing inguinal hernia operations in Japan. From now on, a paradigm shift from the concept of two-dimensional layer structure to the three-dimensional space recognition is necessary to promote an understanding of anatomy.

Concepts: Dimension, Inguinal hernia, Transversalis fascia


Ultrasound (US)-guided transversalis fascia plane block (TFPB) was first described by Hebbard as a technique for blockade of T12-L1 nerves. Although this technique appears similar to the quadratus lumborum 1 block, the point of injection is more caudal and anterior, specifically targeting ilioinguinal and iliohypogastric nerves. There are only few published data on US-guided TFPB demonstrating effective postoperative analgesia in iliac crest bone graft harvesting. We report the use of US-guided TFPB in a patient undergoing inguinal herniorrhaphy. Our experience suggests that this technique could represent a viable alternative to general anesthesia and standard regional techniques for inguinal hernia repair.

Concepts: Surgery, Inguinal hernia, Hernia, Hernias, Herniorrhaphy, Iliac crest, Transversalis fascia, Quadratus lumborum muscle


Many surgical techniques have been used to repair abdominal wall defects in the inguinal region based on the anatomic characteristics of this region and can be categorised as ‘tension’ repair or ‘tension-free’ repair. Tension-free repair is the preferred technique for inguinal hernia repair. Tension-free repair of inguinal hernia can be performed through either the anterior transversalis fascia approach or the preperitoneal space approach. There are few large sample, randomised controlled trials investigating the curative effects of the anterior transversalis fascia approach versus the preperitoneal space approach for inguinal hernia repair in patients in northern China.

Concepts: Randomized controlled trial, Surgery,, Inguinal hernia, Hernia, Abdomen, Hernias, Transversalis fascia


Placement of an inflatable penile prosthesis (IPP) is the most effective treatment modality for men with ED refractory to medical management. We have previously demonstrated a protocol for IPP reservoir placement within the abdominal wall musculature, which was shown to be a safer location than traditional placement in the retropubic space of Retzius. The aim of this study was to review our complications with IPP reservoir entry into the peritoneum after abdominal wall placement of the reservoir. We retrospectively reviewed our two patients with peritoneal entry of the reservoir after posterior to transversalis fascia and anterior to transversalis fascia placement during virgin and compromised IPP cases, respectively. Our goal was to assess common inherent patient and surgical factors that resulted in this complication in order to develop a management algorithm to prevent future occurrence during alternative reservoir placement. Peritoneal reservoir entry was identified in two patients. These patients were both noted to be thin (mean body mass index (BMI) 18.5 kg/m(2)), current or former smokers. Peritoneal entry was identified early after reservoir placement. Neither of the patients suffered bowel injury and both subsequently underwent successful reservoir removal and IPP replacement. Both are currently doing well with functional IPPs on follow-up. Peritoneal entry of the reservoir occurs very rarely and, in our series, occurred in a cohort of patients with low BMI and tobacco use history. We recommend early identification of similar patients and subsequent reservoir placement anterior to transversalis fascia with caution to prevent peritoneal entry.International Journal of Impotence Research advance online publication, 29 June 2017; doi:10.1038/ijir.2017.26.

Concepts: Body mass index, Stomach, Peritoneum, Abdomen, Anders Retzius, Transversalis fascia, Abdominal wall, Extraperitoneal space


Lichtenstein hernioplasty is the number one technique worldwide for open, mesh-based inguinal hernia repair. The principle of Lichtenstein hernioplasty is the tension-free reinforcement of the abdominal wall by covering the transversalis fascia and the oblique muscles with an artificial patch of mesh. The Lichtenstein technique has been modified since its inception. The technique has the benefits of low costs and a rapid learning curve and can be performed with the patient under local anesthesia. The recurrence rates after the Lichtenstein operation are significantly lower compared to open suture repair and equal to laparoendoscopic techniques. Compared to laparoendoscopic techniques the Lichtenstein operation is associated with less severe visceral lesions but more early postoperative and chronic pain; however, the chronic pain rates in long-term follow-up studies are comparable.

Concepts: Surgery, Inguinal hernia, Local anesthesia, Hernia, Abdomen, Hernias, Herniorrhaphy, Transversalis fascia


We summarized the evidence for ultrasound (US) guidance for truncal blocks in 2010 by performing a systematic literature review and rating the strength of evidence for each block using a system developed by the United States Agency for Health Care Policy and Research. Since then, numerous studies of US guidance for truncal blocks have been published. In addition, 3 novel US-guided blocks have been described since our last review. To provide updated recommendations, we performed another systematic search of the literature to identify studies pertaining to US guidance for the following blocks: paravertebral, intercostal, transversus abdominis plane, rectus sheath, ilioinguinal/iliohypogastric, as well as the Pecs, quadratus lumborum, and transversalis fascia blocks. We rated the methodologic quality of each of the identified studies and then graded the strength of evidence supporting the use of US for each block based on the number and quality of available studies for that block.

Concepts: Systematic review, United States, Transversus abdominis muscle, Iliac crest, Muscles of the torso, Transversalis fascia, Iliohypogastric nerve, Quadratus lumborum muscle


Native collagen gels are important biomimetic cell support scaffolds, and a plastic compression process can now be used to rapidly remove fluid to any required collagen density, producing strong 3D tissue-like models. This study aimed to measure the mechanical creep properties of such scaffolds and to quantify any enhanced creep occurring in the presence of cells (cell-mediated creep). The test rig developed applies constant creep tension during culture and measures real-time extension due to cell action. This was used to model extracellular matrix creep, implicated in the transversalis fascia (TF) in inguinal hernia. Experiments showed that at an applied tension equivalent to 15 % break strength, cell-mediated creep over 24-h culture periods was identified at creep rates of 0.46 and 0.38 %/h for normal TF and human dermal fibroblasts, respectively. However, hernia TF fibroblasts produced negligible cell-mediated creep levels under the same conditions. Raising the cell culture temperature from 4 to [Formula: see text] was used to demonstrate live cell dependence of this creep. This represents the first in vitro demonstration of TF cell-mediated collagen creep and to our knowledge the first demonstration of a functional, hernia-related cell abnormality.

Concepts: Collagen, Extracellular matrix, Fibroblast, Cell biology, Cell culture, Inguinal hernia, Demonstration, Transversalis fascia


Indirect inguinal hernias are usually congenital, forming a sac in the core of the spermatic cord covered by the internal spermatic, cremasteric, and external spermatic fasciae(1-3). Direct inguinal hernias are acquired; the sac lies beside/behind the cord(1-3). A rare third type is a combination of indirect and direct sacs on both sides of inferior epigastric vessels(1-3). We describe a rare fourth type, juxtacordal indirect oblique inguinal hernia (Fig. 1), in which the sac emerges through a weakness in the deep inguinal ring, lateral to inferior epigastric vessels, and passes into the inguinal canal beside and in contact with the cord but outside of its covering fasciae.

Concepts: Inguinal hernia, Hernia, Hernias, Inferior epigastric artery, Spermatic cord, Deep inguinal ring, Transversalis fascia, Indirect inguinal hernia