Determination of vascular structures in the retroinguinal and retropubic region

Aim: Surgical interventions in the abdominopelvic cavity can be performed laparoscopically or open with different procedures. In this context, in the anatomy of the inguinal region, the position of the vascular structures relative to certain anatomical structures should be known in the posterior view of the anterior abdominal wall. Because the main purpose in closed surgery of the region is to preserve the general anatomical structure and to ensure that the patient has a less complicated surgical process and a more comfortable post-operative period. The main formations that first appear on the abdominal wall of an eye looking from the inside into the distal abdominal cavity are the deep inguinal ring of the inguinal canal, the ductus deferens, which are the structures passing through this region, and the protuberances of the testicular (or ovarian) vessels, especially a branch that external iliac artery gives to the wall, inferior epigastric artery. Although it is not clearly visible, tractus iliopubicus, which is one of the structures limiting this region, can be counted. The aim of our thesis is to reveal the localization of the vascular structures in the region according to the structures seen endoscopically and palpable bone markers. Materials and Methods: Our study was carried out on cadavers in Ankara University Faculty of Medicine, Department of Anatomy and Ankara Forensic Medicine Institute. One of these cadavers was dissected in the Ankara Forensic Medicine Institute and due to the limitations in post-dissection measurements, it was not evaluated in the measurements, only morphological data were used. Measurements were taken from the other 4 cadavers. These cadavers were prepared by Ankara University School of Medicine. They were 10% formalin fixed cadavers in the cadaver pool. Measurements in the region can basically be counted in several categories. These are pelvic diameter, distance and angle measurements, the measurements of Hesselbach's triangle and falx inguinalis, rectus abdominis, pyramidalis muscles and inguinal canal distance measurements, the measurements of vessels passing over the pectineal ligament to form corona mortis, the measurements of both external iliac and inferior epigastric vessels. According to the point where the inferior epigastric vessels axis crosses the tractus iliopubicus, the measurements of the obturator vessels and accessory obturator artery and are the measurements of the retropubic region. Results: In our study, 5 cadavers with a mean age of 66.75 (55-75) were used. All four cadavers from which measurements were taken were male. The cadaver in the Ankara Forensic Medicine Institute was female. Height and weight approximately were 167.50 ± 5.98 cm (160.00-175.00) and 68.75 ± 17.88 kg (50.00-90.00), respectively. When we look at the general morphological measurements, the angulation of inferior epigastric artery was significant. It was found between 84.96° ± 1.49° (82.00-86.58). When we look at the formation of corona mortis, it was seen in all except one cadaver. All of the variations seen included venous structure, and both vein and artery were seen on only one side. In other words, corona mortis was seen in 80% and all of them had a venous structure. In all examples the pubic branch of the inferior epigastric artery was detected and anastomosis suprapubically at the symphysis plevel with its opposite counterpart, except for one cadaver. Conclusion: In our study, the identification and location of the retropubic and retroinguinal branches which was determined it according to the axis of the inferior epigastic vessels. This was one of the strongest aspects that made our work different. Contrary to what is described in the formation of Corona mortis, venous anastomosis is more frequent and it was determined that it is more associated with accessory obturator vein rather than aberrant obturator vein. The main purpose of our study, we measured the localization of the vascular structures in the region according to the structures seen endoscopically and palpable bone markers, by considering the variations of the regional vessels according to the midline, namely pubic symphysis, anterior superior iliac spine, pubic tubercle, iliopubic tract and deep inguinal ring, and these are going to be as a good guide in procedures.