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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.

  1. Inferior epigastric vessels
  2. Medial umbilical ligament
  3. Spermatic vessels
  4. Vas deferens
  5. Trapezoid of disaster
Inguinal Anatomy with Peritoneum Intact
Inguinal Anatomy with Peritoneum Intact

Inferior epigastric vessels

The inferior epigastric artery is prominently visualized during laparoscopic preperitoneal dissection of groin hernia.

  1. It forms the lateral border of the Hesselbach’s triangle.
  2. It demarcates between direct and indirect inguinal hernia.
  3. It leads us to iliac vessels and apex of triangle of doom.
  4. Bleeding due to its injury can occur during dissection.

Medial umbilical ligament

Urinary bladder lies medial to the medial umbilical ligament.

Spermatic vessels

It forms the lateral border of the ‘triangle of doom’ and the medial
border of the ‘triangle of pain’.

Vas deferens

Forms the medial border of the ‘triangle of doom’ and ‘quadrangle
of disaster’

‘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.

Related Topics

Contact Details

Dr. R. Padmakumar
MBBS, DNB, MNAMS, DipALS, FAIS, FIMSA, FCLS, FRCS (GL)
Senior Consultant Laparoscopic and Metabolic Surgeon &
Director - Verwandeln Institute (Transforming Lives)
(Specialist in Laparoscopy, Hernia, Cancer, Obesity Surgery or Bariatric Surgery, Diabetes Surgery, Endoscopic Thyroid Surgery, Thoracoscopy, Intragastric Balloon)
Keyhole Clinic, Metro Pillar no. 448, Edappally, Kochi, Kerala, India
VPS Lakeshore Hospital, Maradu, Kochi, Kerala, India
Past Chairman - Association of Surgeons of India, Kerala Chapter, 2019-2020

Address

Keyhole Clinic - Center for Obesity and Laparoscopy

Metro Pillar no. 448, Edappally, Kochi, Kerala, India

VPS Lakeshore Hospital

Maradu, Kochi, Kerala


Mobile: +919447230370, +919846320370
Email: [email protected]

Website:
www.drrpadmakumar.com

Past Chairman, Association of Surgeons of India - Kerala Chapter
National President - Indian Hernia Society (2016)
GC Member, Association of Surgeons of India (2013 - 2018)
Vice President- Society of Endoscopic and Laparoscopic Surgeons of India
Jt. Secretary - Indian Association of Endocrine Surgeons (2016)
Founder Member, Obesity and Metabolic Surgery Society Of India
Founder Member, Association of Minimal Access Surgeons of India
International Faculty of IASGO on Hernia and Diabetic Surgery
International Faculty of IFSO on Diabetic Surgery
Associate Editor : Diabetes and Obesity International Journal