Triangle Of Pain

                                                                     Triangle Of Pain

The so-called "triangle of pain" is a misnomer coined by laparoscopic hernia surgeons who observed the anatomy of the inguinofemoral region from the posterior aspect and refers to an inverted "V" shaped area which should be avoided because of the potential to damage nerves when placing staples, tacks, or sutures to anchor a mesh during a laparoscopic herniorrhaphy.

The "triangle of pain" is an inverted "V" shaped area with its apex at the internal (deep) inguinal ring. It is bound anteriorly by the iliopubic tract/ inguinal ligament and by the testicular (spermatic) vessels posteromedially. This "triangle" has no defined posterolateral boundary.

The reason why this area should be avoided and not place staples or sutures to anchor a hernia mesh is that there are several nerves which usually cannot be seen as they run just deep to the end abdominopelvic fascia. These nerves can suffer damage or entrapment  when performing a laparoscopic herniorrhaphy and cause pain (hence the name of the area) as well as motor and sensory disorders.

The nerves are:

• Lateral femoral cutaneous nerve:

• Femoral nerve: 

• Genitofemoral nerve:  

Snapshot