Which other vascular structures are relevant in a totally extraperitoneal (TEP) laparoscopic inguinal hernia repair?

Updated: Apr 16, 2020
  • Author: Danny A Sherwinter, MD; Chief Editor: Kurt E Roberts, MD  more...
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Answer

Other vascular structures should be considered during TEP. There may be a vascular connection between the obturator and external iliac systems, producing a so-called corona mortis. This abnormality is commonly encountered as dissection of the Cooper ligament is taken toward the external iliac vein. Gentle and judicious dissection will limit injury to this structure. Other small veins surround the Cooper ligament and can lead to meddlesome bleeding during TEP.

The surgeon should be mindful of the important nerves in the area as well. The lateral femoral cutaneous nerve travels along the iliopsoas muscle as the nerve courses toward the lateral thigh. The genitofemoral nerve emerges from the psoas muscle medial to the lateral femoral cutaneous nerve. The genital branch of this nerve courses lateral to the spermatic cord and travels through the deep inguinal ring. Both the femoral branch of the genitofemoral nerve and the femoral nerve lie in close proximity to the femoral artery.


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