In a laparoscopic totally extraperitoneal (TEP) repair of an inguinal hernia, the 'triangle of doom' and 'triangle of pain' are critical anatomical hazard zones. Which structure lies within the triangle of doom, making its inadvertent injury catastrophic?

• A External iliac vessels ✓
• B Lateral femoral cutaneous nerve
• C Genitofemoral nerve
• D Vas deferens

Explanation

The triangle of doom is bounded medially by the vas deferens and laterally by the testicular vessels, with its apex at the deep inguinal ring. The external iliac artery and vein pass through this triangle — staple or tack placement here can cause catastrophic hemorrhage. The triangle of pain lies lateral to the testicular vessels (bounded by the iliopubic tract superiorly) and contains the femoral nerve, lateral femoral cutaneous nerve, and genitofemoral nerve; tacking in this zone causes chronic neuropathic pain or numbness.

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.