ANATOMY OF THE PERITONEAL ASPECT OF THE DEEP INGUINAL RING - IMPLICATIONS FOR LAPAROSCOPIC INGUINAL HERNIORRHAPHY

There are a number of important structures to be avoided in suturing o r stapling during laparoscopic inguinal herniorrhaphy, not all of whic h are easily identifiable at laparoscopy. This is particularly so of t he ductus deferens. Measurements were taken of the angle made by the d uctus deferens with testicular vessels, and of the thickness of tissue in the vicinity of the internal ring into which sutures or staples ar e likely to be inserted. The angle (mean +/- SD) made by the ductus wi th testicular vessels was 38.6 degrees +/- 4.4 degrees on the right, a nd 48.6 degrees +/- 7.2 degrees on the left (P < 0.05) (measurements f or right and left sides taken from different cadavers). Thickness of t issue around the ring (peritoneum, transversalis fascia and intervenin g connective tissue) varies at different sites, being greatest lateral to the testicular vessels (2.2 +/- 0.4 mm) and least over the ductus (0.2 +/- 0.1 mm). The angle measured constitutes the apex of the ''tri angle of doom'' (Spaw et al., 1991, J. Laparoendoscopic Surg. 1:269-27 7) and with its use the position of the ductus deferens may be predict ed and the underlying external iliac vessels avoided when stapling dur ing herniorrhaphy. Clin. Anat. 10:313-317, 1997 (C) 1997 Wiley-Liss,In c.