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Corona mortis: in vivo anatomical knowledge and the risk of injury in totally extraperitoneal inguinal hernia repair

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Abstract

Purpose

Corona mortis (CMOR) is the arterial and/or venous vascular communication(s) between the obturator and external iliac vessels. Totally extraperitoneal (TEP) inguinal hernioplasty can be associated with vascular complications especially during the fixation of the mesh. Theoretically, CMOR is an important nominee. But, the data in literature are insufficient about CMOR injury. Additionally, most of the studies about CMOR have been usually performed on cadavers. We aimed to reveal the preperitoneal vascular anatomy of inguinal area and provide in vivo knowledge about CMOR. The risk of arterial injury was also evaluated.

Materials

The data of preperitoneal vascular anatomy of 321 patients who underwent TEP procedure between January 2005 and July 2014 were retrospectively evaluated.

Results

Mean age was 46 ± 8.9 years, 53 females vs 268 males. 391 hemipelvises were evaluated. Two types of arterial structure were identified; (1) an aberrant obturator artery forming an anastomosis with branches of ordinary obturator artery; (2) a pubic branch of inferior epigastric artery. The incidence of arterial CMOR was 28.4 % and of any arterial structure was 45.0 %. An arterial CMOR was considered as thick (≥2 mm) or thin (<2 mm). Injury of arterial CMOR during tack stapling on Cooper’s ligament was seen in six cases (1.5 %). All of them were thin (<2 mm) in structure. Venous CMOR was visible only under low pressure in work space.

Conclusion

During TEP hernia repair, CMOR and/or pubic branch of inferior epigastric artery can be damaged. To prevent this complication, tacks should be stapled to Cooper’s ligament close to symphysis pubis and dissection should be careful on the posterior surface of superior pubic ramus. Small caliber (<2 mm) arterial CMOR is more prone to be injured during TEP procedure. To explore venous structures properly, pressure in workspace should be kept as low as possible.

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Acknowledgments

The abstract has been presented as a poster presentation in 12th Congress of Turkish National Endoscopic Laparoscopic Surgery, April, 22th–26th, 2015, Antalya, Turkey. We offer our special thanks to Mr. Yunus Emre Kinaci for his kind support to our study with excellent drawings.

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Authors and Affiliations

  1. Department of General Surgery, Faculty of Medicine, Inonu University, Malatya, Turkey

    M. Ates, V. Soyer, B. Sarici & A. Dirican

  2. Department of Anatomy, Faculty of Medicine, Inonu University, Malatya, Turkey

    M. Ates, E. Kose, S. Cuglan & F. Korkmaz

  3. Department of General Surgery, Faculty of Medicine, Inonu University (Works in fellowship program), Malatya, Turkey

    E. Kinaci

  4. Department of General Surgery, Istanbul Training and Research Hospital, Istanbul, Turkey

    E. Kinaci

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  1. M. Ates
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  2. E. Kinaci
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  3. E. Kose
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  4. V. Soyer
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  5. B. Sarici
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  6. S. Cuglan
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  7. F. Korkmaz
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  8. A. Dirican
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Correspondence to E. Kinaci.

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The authors declared that they have no conflict of interests.

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E. Kinaci works in fellowship program.

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Ates, M., Kinaci, E., Kose, E. et al. Corona mortis: in vivo anatomical knowledge and the risk of injury in totally extraperitoneal inguinal hernia repair. Hernia 20, 659–665 (2016). https://doi.org/10.1007/s10029-015-1444-8

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  • DOI: https://doi.org/10.1007/s10029-015-1444-8

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