During laparoscopic inguinal hernia repair (TEP/TAPP), the 'triangle of doom' is a critical vascular area the surgeon must avoid. What are the boundaries and contents of the triangle of doom?

• A Medial boundary: vas deferens; lateral boundary: testicular vessels; contents: external iliac vessels (artery and vein) ✓
• B Medial boundary: medial umbilical ligament; lateral boundary: inferior epigastric vessels; contents: femoral nerve
• C Bounded by the inguinal ligament, iliopubic tract, and Cooper's ligament; contains obturator vessels
• D Bounded by the vas deferens, Cooper's ligament, and pubic symphysis; contains femoral artery

Explanation

The 'triangle of doom' in laparoscopic hernia repair is the triangular space bounded medially by the vas deferens (in males) or round ligament, and laterally by the testicular (gonadal) vessels. The external iliac artery and vein lie within this triangle. Inadvertent dissection or stapling into this triangle can cause catastrophic vascular injury. The related 'triangle of pain' is lateral to the testicular vessels and contains the femoral nerve and lateral cutaneous nerve of thigh; tacking staples into this region causes chronic neuropathic pain. Both triangles guide safe mesh fixation in laparoscopic herniorrhaphy.

Reference: BD Chaurasia's Human Anatomy, 8th ed.

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Written and medically reviewed by the StethoPrep medical team.