A 45-year-old man undergoes laparoscopic totally extraperitoneal (TEP) inguinal hernia repair. During dissection, the surgeon identifies the 'triangle of doom' and 'triangle of pain.' What structure is at highest risk if dissection enters the triangle of doom?

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

Explanation

The 'triangle of doom' in laparoscopic inguinal hernia repair is bounded by the vas deferens medially and the testicular vessels laterally; the external iliac artery and vein run within this triangle. Inadvertent dissection or stapling here can cause catastrophic vascular injury. The 'triangle of pain' is lateral to the testicular vessels (gonadal vessels), containing the lateral femoral cutaneous nerve and femoral branch of the genitofemoral nerve — stapling here causes chronic pain/paresthesia. Understanding these anatomical landmarks is essential for safe TEP and TAPP procedures.

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.