Inguinal Anatomy with Peritoneum Intact
With the introduction of the laparoscope into the abdomen, five important landmarks can be identified in the infra-umbilical region.
- Inferior epigastric vessels
- Medial umbilical ligament
- Spermatic vessels
- Vas deferens
- Trapezoid of disaster
Inferior epigastric vessels
The inferior epigastric artery is prominently visualized during laparoscopic preperitoneal dissection of groin hernia.
- It forms the lateral border of the Hesselbach’s triangle.
- It demarcates between direct and indirect inguinal hernia.
- It leads us to iliac vessels and apex of triangle of doom.
- Bleeding due to its injury can occur during dissection.
Medial umbilical ligament
Urinary bladder lies medial to the medial umbilical ligament.
It forms the lateral border of the ‘triangle of doom’ and the medial
border of the ‘triangle of pain’.
Forms the medial border of the ‘triangle of doom’ and ‘quadrangle
‘Trapezoid of Disaster’ (Labeled by Seid)
Lying beneath the peritoneum and transversalis fascia are the external iliac artery and vein and nerves- triangle of pain + triangle of doom
Dissection should be done with care in this area. No tacks should be placed in this area.
About Dr. R. Padmakumar
Dr. R. Padmakumar is one of the Best Hernia Surgeon in India. He has been changing lives through Keyhole Surgery. He has got more than 30 years of hands-on experience in laparoscopic Surgery in major hospitals across India and has completed more than 7000 cases of Laparoscopic Hernia Surgeries. Dr. Padmakumar has trained more than 300 surgeons from all over the world the art of laparoscopic surgery especially Laparoscopic Hernia Surgery. Dr. Padmakumar is also hailed as one of the Best Bariatric Surgeon in India & UAE. He is renowned for new and improved treatment techniques and the first in the World to perform Scarless Bariatric Surgery with Tummy Tuck / Abdominoplasty. He is also one of the very few thyroid surgeons in India doing Endoscopic Thyroidectomy (scarless thyroid surgery).