29/04/2026
Laparoscopic inguinal hernia repair consists mainly of two standard laparo-endoscopic techniques: TAPP and TEP.
TAPP (Transabdominal Preperitoneal repair) enters the peritoneal cavity first, after which mesh is placed in the preperitoneal space. It provides easier anatomical visualisation and is generally considered simpler to learn, although it carries a higher risk of visceral injury, adhesions, and bowel-related complications.
TEP (Totally Extraperitoneal repair) is performed entirely within the preperitoneal space without entering the peritoneal cavity. This reduces the risk of intraperitoneal complications and adhesion-related problems, but the smaller working space makes the procedure technically more demanding.
The “5 triangles” concept is mainly a TAPP-oriented anatomical teaching system designed to improve the critical view of safety and help surgeons avoid dangerous fixation zones during laparoscopic groin hernia repair.
The Triangle of Doom is bounded by the vas deferens medially and the gonadal vessels laterally, containing the external iliac vessels and representing a major vascular danger zone.
The Triangle of Pain lies lateral to the gonadal vessels and below the iliopubic tract; it contains important nerves including the femoral branch of the genitofemoral nerve and the lateral femoral cutaneous nerve, making tack fixation in this area a cause of chronic neuropathic pain.
The Indirect Triangle relates to the deep inguinal ring and lies lateral to the inferior epigastric vessels.
The Direct Triangle corresponds to Hesselbach’s area, the site of direct inguinal hernias.
The Femoral Triangle relates to the femoral canal region and the territory of femoral hernias.
7 hours condensed work over a month
Via Adobe Illustrator & Adobe Photoshop
By Reda Harby
