During laparoscopic TAPP (transabdominal preperitoneal) inguinal hernia repair, a 'triangle of doom' is identified. Damage to structures within this triangle causes the most catastrophic vascular injury. What are the boundaries of the triangle of doom?

• A Medial: vas deferens; lateral: testicular vessels; apex: deep inguinal ring ✓
• B Medial: epigastric vessels; lateral: iliopubic tract; apex: pubic tubercle
• C Medial: Cooper's ligament; lateral: femoral vein; apex: lacunar ligament
• D Medial: vas deferens; lateral: peritoneal edge; apex: internal ring

Explanation

The 'triangle of doom' in TAPP repair is delineated by the vas deferens medially and the testicular vessels (gonadal vessels) laterally, with the apex at the deep inguinal ring. This triangle contains the external iliac vessels and should not be stapled or dissected. The 'triangle of pain' is a separate lateral triangle (between the testicular vessels medially and the iliopubic tract laterally) containing the femoral nerve and lateral femoral cutaneous nerve, where staplers should be avoided to prevent neuralgia.

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

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Written and medically reviewed by the StethoPrep medical team.