To observe fat morphology and blood vessel distribution by anterior posterior sheath approach under laparoscope, and to discuss the attribution of fat and the anatomical key points of the level.

Video data of 30 cases of totally extra-peritoneal hernia repair (TEP) performed by anterior posterior approach in Qingdao Fuwai Cardiovascular Hospital and the Affiliated Hospital of Qingdao University from January 2022 to May 2023 was retrospectively analyzed. Surgical paths, anatomical markers, especially fat attribution of TEP were analyzed.

30 cases were operated successfully, the attribution of yellow fat under the whole anterior posterior approach is stratifier-oriented, whether in the initial space in the anterior posterior sheath or in the preperitoneal space in the surgical area, including the Retzius and Bogros Spaces. Important anatomical markers: anterior bladder fascia, pectineal ligament, external iliac blood vessel, subabdominal blood vessel, vas deferens (round ligament of uterus), genital vessels, corona mortis, dangerous triangle, femoral lateral cutaneous nerve, genital femoral nerve, obturator nerve and obturator artery, etc. All of them have yellow fat levels, and involve attribution issues. By the attribution of the fat, we can complete spermatic cord deperitonealization effectively and safely, prevent peritoneal tears and reduce complications, manage the hernia sac effectively, and complete the TEP surgery safely, effectively and with high quality.

The correct attribution of fat and the clear anatomy of the layer have great significance for the laparoscopic TEP inguinal hernia repair. Knowing the attribution of fat is conducive to shorten the learning curve of TEP and control the operation method more effectively, which benefits both the surgeon and the patient.