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October 2004

The Preperitoneal Space

Arch Surg. 2004;139(10):1129. doi:10.1001/archsurg.139.10.1129-a

I feel akin to the Princes of Serendip, who in the Persian fairy tale, had the gift of finding agreeable things not sought for. Soon after I submitted a manuscript regarding the use of the term preperitoneal, I attended the annual meeting of the American Hernia Society. There, Dr Amid1 invited me to consider his recent Commentary.

Amid's concern was obliteration of the preperitoneal space, rendering subsequent vascular or urological surgery "difficult, if not impossible."1(p130) His implication is that awarding the gold standard to the Lichtenstein procedure makes the use of the preperitoneal space exploitative. This problem was addressed at the American Hernia Society meeting in Orlando, Fla, by urologists and herniologists. The consensus seemed to be "first come, first served" because only a minority of patients with hernia will require later operations. Furthermore, approaches other than a retropubic one can be used to operate on the prostate or iliac vessels. Nevertheless, Amid's suggestion is creative. With considerable experience using prosthetic sandwiches for the intraperitoneal placement of mesh, we need to investigate their use in the Bogros space.