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Anterior interspinous line (AISL) is defined as the horizontal line joining the two anterior superior iliac spines. It has been used as an important reference point not only during clinical examinations such as for determining the angle of fixed abduction/adduction deformity of the lower limb under the Kothari‘s method [1] but also during planning of the rectus abdominis myocutaneous flap/ abdominoplasty [2-4] and stoma formation [5]. Anterior interspinous line is also important in hernia surgery, and it defines the lower boundary of the Spigelian hernia belt [6-8]. In view of its huge potential of use in surgery, the relationship of the anterior interspinous line with four other landmarks (3 external surface landmarks of umbilicus, xiphisternum and pubic symphysis as well as 1 internal landmark of the Arcuate line of Douglas) were studied during the laparoscopic total extraperitoneal preperitoneal (TEPP) hernia repair in patients with inguinal hernia. Abstract: In addition to open surgery such as rectus abdominis flap harvest and stoma formation, anterior interspinous line joining two anterior superior iliac spines has also become an important surgical landmark during laparoscopic surgery including total extraperitoneal preperitoneal (TEPP) repair for inguinal hernia. Relations of interspinous line with four other surface landmarks (Xiphisternum, umbilicus, pubic symphysis, and arcuate line of Douglas) were studied during TEPP hernioplasty in Indian male population. Mean distances of the interspinous line from xiphisternum, umbilicus, pubic symphysis, and arcuate line were 23.82 ± SD 2.49 (Range 19.5-29.0 cm), 9.17 ± SD 1.83 cm (Range 5.25-13.4 cm), 6.79 ± SD 1.67 (Range 1.1-9.25 cm), and 3.71 ± SD 2.32 (Range, -1.5 to 9.5 cm) respectively . Anterior interspinous line was found situated at 57.56% of umbilico-pubic distance, at 42.62% of pubo-umbilical distance, at 78.15% of xiphisterno-pupic distance, and at 22.28% of pubo-xiphisternal distance. Exact location of anterior interspinous line relative to other surface landmarks or vice versa may prove more useful in a number of clinical situations including in detection/quantification of fixed lower limb deformity, in diagnosis of Spigelian hernia, in siting of Lanz incision for appendicectomy or incision for stoma construction well above Arcuate line, in making incision for abdominoplasty/rectus abdominis myocutaneous flap harvest well above Arcuate line, in re-positioning of umbilicus after reconstructive/aesthetic surgery and in placement of middle port at or below arcuate line during TEPP hernioplasty. Validation of our results is recommended in Indian and Non-Indian populations by more research work with larger sample size in clinical settings.

Interspinous Line: Relations with Other Landmarks (Xiphisternum, Umbilicus, Pubic Symphysis and Arcuate Line of Douglas) and Importance for Surgeons