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 (C2 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.
