In the TEP (totally extraperitoneal) laparoscopic hernia repair, the dissection plane developed is between the posterior rectus sheath and the peritoneum (preperitoneal space). The lateral limit of dissection must extend beyond which structure to prevent lateral recurrence?
- A Psoas muscle — lateral to the triangle of doom ✓
- B Anterior superior iliac spine
- C Cooper's ligament
- D Iliopubic tract
Correct answer: A. Psoas muscle — lateral to the triangle of doom
Explanation
In TEP repair, adequate lateral dissection must extend to the level of the anterior superior iliac spine and beyond the psoas muscle, staying lateral to the 'triangle of doom' (bounded by the gonadal vessels and vas deferens, containing the external iliac vessels) and above the 'triangle of pain' (containing the femoral branch of genitofemoral nerve and lateral femoral cutaneous nerve). Inadequate lateral dissection leads to lateral (indirect) recurrence. The mesh must cover all three potential hernia orifices: indirect, direct, and femoral.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.