Acetabulum – Ilioinguinal Approach

Acetabulum – ilioinguinal approach

• position – supine with GT @ edge of table
– need catheter

• incision – curved ant. Incision starting 5cm above ASIS
– 1cm above pubic tubercle to midline

* no internervous plane

* dissection
– incise subcut. fat
– expose aponeuroses of ext. oblique
– lat. fem. cut. n. in lat. edge of dissection
– divide ext. oblique from superficial inguinal ring to ASIS
– ID round lig. or spermatic cord = med. bundle
– divide ant. part of rectus sheath to expose underlying rectus
– strip iliacus from inside of wing of ilium –> can expose SI joint
– divide rectus transversely 1cm prox. to insertion
– develop plane btw back of symphysis & bladder = space of Retzius)
– peel fibers of int. oblique & transversus from inguinal lig. –> avoids inf. epigastric art. & deep inguinal ring
– push peritoneum upwards to expose ext. iliac vessels
– isolate ext. iliac vessels = middle bundle
– isolate iliopsoas & fem. n. = lat. bundle
– expose med. surface of acetabulum & sup. pubic ramus

* dangers
– fem. n. – runs beneath inguinal lig. lying on iliopsoas; avoid excessive retraction

– inf. epigastric art. – passes med. to deep inguinal lig.

– spermatic cord – contains vas deferens & testicular art.

– bladder – easily mobilized off back of symphsis

– corona mortis
> anastomosis of branch of obturator art. & ext. iliac art.
> occurs in 25-30% of patients
> on undersurface of ext. iliac art.