A 55-year-old man undergoes laparoscopic TAPP (transabdominal preperitoneal) repair for a right inguinal hernia. The anatomical landmark called the 'triangle of doom' in laparoscopic hernia repair must be avoided to prevent injury to which structure?

• A Inferior epigastric vessels
• B Femoral nerve
• C Vas deferens
• D External iliac vessels (external iliac artery and vein) ✓

Explanation

In laparoscopic inguinal hernia repair, the 'triangle of doom' is the triangular area bounded medially by the vas deferens and laterally by the testicular vessels (gonadal vessels), with the base formed by the peritoneal fold. The external iliac artery and vein pass through this triangle — inadvertent stapling or dissection here can cause catastrophic hemorrhage. The 'triangle of pain' (bounded laterally by the iliopubic tract and medially by the testicular vessels) contains the lateral femoral cutaneous nerve, femoral branch of the genitofemoral nerve, and femoral nerve — stapling here causes chronic neuralgic pain.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.