**4. Anatomy**

have been described and most of the surgeons engaged in this procedure have completed learning curves a long time ago. In 1984, about hernia, Sir Astley Paston Cooper says: "No disease from the human body, belonging to the surgeon, demands in its treatment, a better mixture of precise, anatomical knowledge along with surgical skill, compared to hernia in most of its variations". In this chapter, the details and results of two laparoscopic techniques, which have become common in inguinal hernia treatment today, are evaluated in detail.

The incidence of inguinal hernia varies according to age and sex. There is a bi-modal distribution in males and it increases in the first year of life and in older ages. The rate of 15% in the second decade increases with age and reaches 47% in the seventh decade. In females, this rate is 3% for life. There is a significant difference between the male/female ratio and is reported as 1:15. Although the majority of the inguinal hernia patients do not face great problems in resuscitating their lives, the incidence of general incidence and emergency case incidence

Inguinal hernias are classified as direct or indirect inguinal hernia according to their mechanism and anatomical characteristics. Indirect inguinal hernias are the most common subtype and the risk of strangulation is much higher compared to direct hernias. In the case of strangulation, it is also necessary to mention that the femoral hernias head to this issue. Femoral hernias, which are found in 70% of women and generally settled in the principle of "should be fixed when they are detected", due to the risk of strangulation, have not been included in this section [2].

When the side is concerned, it is a fact that all inguinal hernias are seen more on the right side. One of the theories developed to explain this is that there is anatomically protective effect of the sigmoid colon present on the left side and delayed atrophy of the processus vaginalis due to the slower descent of the scrotum on the right side during embryological development.

The word "hernia" came from the Latin word "rupture" and was described as a disease in the first fifteenth century in papyrus. The idea of repairing surgery came out between fifteenth and seventeenth centuries although the inguinal region anatomy has been described in detail by Hesselbach, Cooper, Camper, Scarpa and Gimbernat during eighteenth and nineteenth centuries. In the twentieth century, "tension-free repairs" started to be proposed and in the last 25 years, parallel to technological developments, videoscopic repairs became widespread. As a result of this development, surgical procedures have now become the standard procedure for "strengthening the abdominal wall in the transverse fascia plan" and are accepted

The idea of laparoscopic repair was first alleged by Ger in 1982 by the collapse of the internal loop. In 1990, Schultz used transperitoneal plugs and developed the intraperitoneal onlay mesh (IPOM) technique, which was performed in the same year by patching the Fitzgibbons

**2. Incidence and general information**

74 Hernia Surgery and Recent Developments

(incarceration-strangulation) increases with age [1].

**3. History**

all over the world [3].

In the inguinal region, four different types of hernia—indirect, direct, femoral and obturator—can develop. One of the most important advantages of the posterior approach is the ability to reveal the entirety of hernia types. There are median, medial and lateral ligaments in the anterior wall of the abdomen after fetal period, followed by urachus obliteration, umbilical artery obliteration and inferior epigastric vessels, respectively. In addition, there are iliopubic tractus, pectineal ligament (Cooper) and lacunar ligament in pubic region, pubic tubercule, spina iliaca anterior superior (SIAS) and superior pubic ramus bones [5].

There are two potential gaps in the preperitoneum. The "Bogros gap" is located between the transverse fascia and the peritoneum. Preperitoneal fatty tissue and porous connective tissue fill this area. The medial part of the preperitoneal cavity on the bladder is known as the "Retzius cavity". The posterior view angle allows examination of the myofektineal orifice, which is a relatively weak part of the abdominal wall and is divided by the inguinal ligament [6].

The external iliac vessels are anastomosed with the inferior epigastric vessels and the superior epigastric vessels. They supply the abdominal wall and penetrate the rectus abdominus through the cranial route within the vagina musculature rectus. Posteriorly inspected anulus inguinalis profundus will reveal the deep location of inferior epigastric vessels. In addition, the aberrant obturator arteries formed by the anastomosis of the pubic ramus of the epigastric artery with the obturator artery, known as "Corona Mortis", constitute the basis of the death triangle. The medial side of this triangle is vas deferens, the lateral side is the spermatic cord and the posterior border is the peritoneal margin.

The inferolateral border of the iliopubic tract, the superomedial border of the gonadal vessels and the lateral border of the peritoneal catheter is defined as the area of the pain triangle and the intermediate cutaneous branches of the lateral femoral cutaneous nerve, the femoral branch of the genitofemoral nerve and the anterior branch of the femoral nerve contain posterior anatomical approach.
