PMC3015571_01
Direct inguinal hernia defect as viewed through the extraperitoneal space of Retzius.
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F1
A large hernia defect could be seen and contents could be easily reduced while the extraperitoneal insufflation pressure was maintained at 15 mm Hg (Figure 1).
The hernia defect as viewed intraperitoneally. Note the peritoneum loosely hanging medially and anteriorly due to previous dissection of the space of Retzius.
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F2
The hernia defect was visualized intraperitoneally (Figure 2).
The completed mesh onlay hernioplasty.
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F3
The mesh onlay was secured with the laparoscopic tack device Protac (United States Surgical, Norwalk, CT) to Cooper's ligament, the rectus sheath, and laterally to the iliopubic tract (Figure 3).