During laparoscopic totally extraperitoneal (TEP) inguinal hernia repair, the surgeon enters the preperitoneal space and identifies the 'triangle of doom.' The structures at RISK of injury within this triangle are:

• A Inferior epigastric vessels and vas deferens
• B External iliac artery and vein ✓
• C Lateral cutaneous nerve of thigh and femoral nerve
• D Ilioinguinal nerve and iliohypogastric nerve

Explanation

The 'triangle of doom' in laparoscopic inguinal hernia repair (TEP/TAPP) is bounded medially by the vas deferens, laterally by the gonadal vessels (testicular vessels), and inferiorly by the peritoneal fold. The external iliac artery and vein course through this triangle and are at risk of catastrophic vascular injury if mesh tacks or staples are placed within it. The 'triangle of pain' (lateral to gonadal vessels and above ilio-pubic tract) contains the lateral cutaneous nerve of thigh and femoral nerve/branch, risking chronic pain if tacked. Inferior epigastric vessels are medial landmarks, not within the triangle of doom.

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

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Written and medically reviewed by the StethoPrep medical team.