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Triangle of Pain in TAPP
Case description
The triangle of pain is an important anatomical area encountered during laparoscopic repair of Inguinal Hernia, especially in transabdominal preperitoneal repair (TAPP) and totally extraperitoneal repair (TEP). It is called the “triangle of pain” because it contains several sensory nerves, and tacks or sutures in this area may cause chronic postoperative groin pain. The triangle of pain is bounded by:
Medially: the gonadal vessels,
Superiorly: the Iliopubic tract
Laterally: the peritoneal reflection over the lateral abdominal wall.
This triangle contains major nerves supplying the thigh and groin: lateral femoral cutaneous nerve, femoral branch of the genitofemoral nerve, sometimes branches of the femoral nerve. During mesh fixation in transabdominal preperitoneal repair (TAPP): No tacks, sutures, or staples should be placed in the triangle of pain, fixation laterally should be avoided to prevent nerve injury.
Injury may lead to: chronic groin pain, burning pain in the lateral thigh, numbness or paresthesia. Surgeons often follow a simple rule: fix mesh only above the iliopubic tract and medially on Cooper’s ligament, avoid fixation below the iliopubic tract laterally (triangle of pain).
