Crucial anatomy and technical cues for laparoscopic transabdominal preperitoneal repair: Advanced manipulation for groin hernias in adults

Figure 8 Triangle of doom and triangle of pain. Triangle of doom and triangle of pain should be adequately recognized by the surgeon. Triangle of doom is an inverted V-shaped area bound laterally by the gonadal vessels and medially by the vas deferens in male patients, or the round ligament in female patients. The EIA, external iliac vein, deep circumflex iliac vein, genital branch of the genitofemoral nerve, and femoral nerve are involved in this area. Area of the triangle of pain involves the femoral branch of the genitofemoral nerve, lateral femoral cutaneous nerve, femoral nerve, and the anterior cutaneous branch of the femoral nerve. Even a subtle injury to the nerves located within the triangle of pain is a risk factor for intractable pain. ARM: Abdominal rectal muscle; EIA: External iliac artery; EIV: External iliac vein; Gb-GFN: Genital branch of the genitofemoral nerve; IPT: Iliopubic tract; LFCN: Lateral femoral cutaneous nerve; VD: Vas deferens.