The obturator artery and vein are usually described as branches or tributaries of the internal iliac vessels although variations with connections to the external iliac or inferior epigastric vessels have been reported. Because these anomalous vessels are at risk in groin or pelvic surgeries that require dissection or suturing along the pelvic rim, we measured the frequency of these variations in 105 pelvic walls (45 in the United States and 60 in China). Our data show that 70-82% of pelvic halves and 83-90% of whole pelves had an artery, vein, or both in the variant position. Arteries were most often found in the normal position only but normal and anomalous veins were most frequently found together. These data show that it is far more common to find a vessel coursing over the pelvic rim at this site than not and have implications for both pelvic surgeons and anatomists.
The high recurrence rate of inguinal hernias following primary repair has prompted us to re-examine the anatomy of the inguinal region with particular emphasis on the iliopubic tract (IFT). The IPT is described as an aponeurotic band forming the inferior margin of the transversus abdominis lamina. We documented the presence and degree of development of the IFT in dissections of 151 embalmed inguinal regions and in serial sagittal sections of four body halves. The iliopubic tract was identified in all specimens. It stretched between the anterior superior iliac spine laterally and the pubic tubercle and pectineal line rnedially. The intervening arch formed a discrete structure of variable thickness and was substantial in 63 specimens. Histological sections demonstrated that the IPT is connected to the inguinal ligament, fascia lata, and anterior femoral sheath and is composed primarily of collagenous fibers with a minor elastic component. These data indicate that the iliopubic tract is a consistent and easily identified structure in the inguinal region. These results suggest that dissection of the iliopubic tract, like the inguinal ligament, should become an integral part of the assessment of groin anatomy during hernia repair. 0 1992 Wiley-Liss, Inc.
Laparoscopic repair of inguinal hernias is gaining acceptance in the repertoire of the general surgeon. However, nerve entrapment sequelae have been reported and appear to be higher with the laparoscopic approach. Contributing factors include pelvic variations in nerve pathways and the use of staples. We examined the pelvic relations of the lateral femoral cutaneous nerve (LFCN) to the anterior superior iliac spine (ASIS) and the iliopubic tract (IPT) because of the high morbidity of entrapment of this nerve, despite its low incidence. The LFCN, ASIS, and IPT were identified and their relationships measured in 48 male and 24 female cadavers ranging in age from 61 to 96 yr. The LFCN was located 1.7 (+/- 1.2) cm medial to the ASIS along the IPT and 1.4 (+/- 0.7) cm posterior (deep) to the IPT at this point, with no significant sex differences. The intrapelvic pathway of the LFCN, including its branches, varied widely so that in 18% of these specimens the LFCN was in either the vertical plane of the ASIS (13%) or in the plane of the IPT (5%). In 11% this nerve was within 1 cm of the ASIS. These data indicate that exclusive use of the ASIS as a guide for staple placement may result in entrapment of this nerve or its branches.
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