To explore the reliability, safety and efficacy of artificial arcuate line in totally extraperitoneal (TEP) patients with low or no arcuate line.

Sixty patients with variations of arcuate line undergoing TEP from July 2016 to August 2019 in Chashan Hospital of Guangdong Medical University were retrospectively studied. A transverse artificial line was surgically created at the middle of the umbilicus and symphysis pubis, and the preperitoneal space posterior to it was separated. Complication analysis and postoperative follow-up were recorded.

The low arcuate line showed incomplete posterior rectus sheath (50 cases with 8-12 cm below umbilicus, 83.3%) with attenuated fibers extending to the pubic bone, while absent arcuate line presented a long aponeurotic rectus sheath extending onto the pubic bone (10 cases, 16.7%). The transverse cleavage in the posterior rectus sheath divided the retropubic space into two different spaces: the anterior space was a continuation of the posterior rectus space; and the posterior to this was the true preperitoneal space situated between the transversalis fascia and the superficial layer of preperitoneal fascia, which extended to Retzius space. Bogros space between the peritoneum and the deeper layer of the preperitoneal fascia was then freed. The mean operation time was (130±15) min. The incidence of peritoneum injury was 8.3% (5/60), no epigastric vessels were injured. There were three hematoma and two seroma. No recurrence was found after an average follow-up of 25 months.

The special technique of artificial creation of arcuate line in TEP patients with low or absent arcuate line was safe, efficient, and was strongly recommended.