During laparoscopic totally extraperitoneal (TEP) hernia repair, which anatomical landmark defines the 'triangle of doom' and the neurovascular structures at risk within it?

• A Triangle between medial umbilical ligament and inguinal ligament; contains external iliac vessels
• B Triangle bounded by vas deferens medially, testicular vessels laterally, and peritoneal fold superiorly; contains external iliac artery and vein ✓
• C Triangle bounded by pubic bone, lacunar ligament, and femoral vein; contains femoral nerve
• D Triangle between inferior epigastric vessels and internal ring; contains deep circumflex iliac vessels

Explanation

The 'triangle of doom' in laparoscopic inguinal hernia repair is delineated by the vas deferens medially and the gonadal vessels (testicular vessels) laterally, with the peritoneal fold forming the superior boundary. Within this triangle lie the external iliac artery and vein, which must not be stapled or sutured during mesh fixation. The adjacent 'triangle of pain' (lateral to the gonadal vessels and inferior to the iliopubic tract) contains the lateral femoral cutaneous nerve, genitofemoral nerve, and femoral nerve, which are at risk for neuralgia if mesh staples are placed there.

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

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Written and medically reviewed by the StethoPrep medical team.