Mastering Hernia Surgery - 4: Applied anatomy for Laparoscopic Inguinal hernia - Edusurg Clinics
Channel: Edusurg Clinics
Date: 25/02/2024

This educational video provides a comprehensive overview of inguinal hernia anatomy, shedding light on the key structures and mechanisms involved in this common medical condition. 
Laparoscopic inguinal hernia anatomy has been nicely described using the Furtado anatomical concept of inverted Y and 5 triangles. The triangle of doom and triangle of pain are also discussed in this video. 
Inguinal hernia anatomy for laparoscopic surgery has been described using the inverted Y and 5 triangle concept of Furtado et al. It is one of the most simplified and practical anatomical descriptions of this area. 
The inferior epigastric artery above the ilio pubic tract, vas deferens medially and spermatic vessels laterally form the inverted Y in this region.
The supra-ilio pubic tract or the anterior area as per Furtado is divided by inferior epigastric artery in to medial area where the direct hernias are seen and lateral area where the indirect inguinal hernias are seen.
The infra- ilio pubic tract or the posterior area as per Furtado is divided into three parts with the area showing the femoral hernia as most medial triangle, the triangle of doom and the triangle of pain from medial to lateral respectively. 
The triangle of doom has its apex at the deep inguinal ring and the sides are formed by the vas deferens medially and spermatic vessels laterally. Its base is formed by the peritoneal reflection.
External iliac artery and vein lie deeper to the triangle of doom area and that is why it is named so. The clinical significance of this triangle is that no tacker should be applied at the triangle of doom area to avoid vascular injury during the hernia surgery
The triangle of pain is has one of its corners at the deep inguinal ring and the sides are formed by the spermatic vessels medially and the ilio pubic tract laterally. Its base is formed by the peritoneal reflection. Some studies suggest that the triangle extends 1-2 cms above the ilio pubic tract.
Femoral nerve, femoral branch of genitofemoral nerve and lateral cutaneous nerve of thigh are present deep to this triangle. The clinical significance of this triangle is that no tacker should be applied at the triangle of pain area to avoid chronic post-operative pain.


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