Clin Surg | Volume 2, Issue 1 | Short Communication | Open Access

Artificial Arcuate Line: Surgical Creation during TEPP Hernioplasty

Maulana M Ansari*

Department of Surgery, J. N. Medical College, Aligarh Muslim University, Aligarh, UP, India

*Correspondance to: Maulana Mohammed Ansari 

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Level and technique of entry into the preperitoneal space during Total Extraperitoneal Preperitoneal (TEPP) hernioplasty is always a matter of dilemma, differing markedly among the experts across the globe. In presence of long posterior rectus sheath with low arcuate line of Douglas and complete posterior rectus sheath with absent arcuate line, a transverse cleavage in the posterior rectus sheath was surgically made at or just below the mid-point of the umbilico-pubic distance to mimic the classical arcuate line in order to keep the ‘effective rectus sheath canal’ to within 2 cm for optimal surgeon’s ergonomics, excellent endoscopic vision, and ample working space. The level of the transverse cleavage in the posterior rectus sheath, i.e., surgical creation of the artificial arcuate line, corresponded to the level of the middle working port in the 3-midline-port technique of TEPP hernioplasty, and proved extremely rewarding without failing and is strongly recommended.


Arcuate line; Artificial arcuate line; TEPP hernioplasty; Low arcuate line; Absent arcuate line; Long posterior rectus sheath; Complete posterior rectus sheath


Ansari MM. Artificial Arcuate Line: Surgical Creation during TEPP Hernioplasty. Clin Surg. 2017; 2: 1698.

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