Optical illusions quintuple during laparoscopic total extraperitoneal preperitoneal (TEPP) hernioplasty: A case report

Optical illusion is a critical factor for bile duct injury during laparoscopic cholecystectomy, but it has never been reported in literature except for a recent report by the author (Ansari MM. Clin Med Imag Int J 2018; xx: xx-xx.(in Press)). A 35-year old man presented with bilateral indirect inguinal hernia. Bilateral laparoscopic total extraperitoneal preperitoneal (TEPP) hernioplasty was performed with 3-midline-port technique through posterior rectus sheath approach. During right hernioplasty, five transient optical illusions were encountered, namely, secondary vs. primary arcuate line, complete vs. incomplete posterior rectus sheath, attenuated lower part of complete posterior rectus sheath vs. transversalis fascia, second layer of double-layered posterior rectus sheath vs. transversalis fascia, and actual vs. virtual junction of secondary arcuate line & Spigelian fascia. Significant technical difficulties were experienced, completing the procedure in 3 hours. Left TEPP repair showed mirror anatomy similar to the right side, and was completed smoothly in 1 hour.