Lumbo-iliac surgical space: Anatomical study and implications in the laparoscopic approach of chronic inguinal pain

Abstract

Introduction: The development of new interventions, such as triple laparoscopic neurectomy, requires precise anatomical knowledge to avoid inadvertent injuries. The lumboiliac space, limits and content are described, to facilitate surgeons a safe approach in the surgery of chronic neural pain. Material and method: Between January 2017 and May 2018, 10 adult cadavers were formalized at 10%, in the Anatomy Department of the Faculty of Medicine of the Catholic University of Murcia. Extraperitoneal compartment was analysed based on its local relationships. All dissections were photographed and recorded for further evaluation. A complementary clinical study was also performed in 5 patients, using a laparoscopic approach in patients with intractable chronic inguinal pain. Results: The surgical lumbo-iliac space, its access planes, limits and content are described. Two triangles are analysed based on the content. The lumbosacral fascia is described, based on a safer surgery. Conclusion: To facilitate the understanding of the anatomy and perform a triple neurectomy with the greatest possible safety, the lumbo-iliac space is described. The space contains 2 triangles delimited by the iliolumbar ligament and in each of them two nerves can be located to proceed with its section. The lumboiliac fascia has variations of surgical interest to avoid vascular injuries of the iliolumbar-circumflex iliac.