Corona Mortis in Patients Undergoing TEP for Inguinal Hernia

Corona mortis is classically defined as the arterial and/or venous vascular anastomosis between the obturator artery and external iliac artery (most commonly the inferior epigastric artery) that crosses the posterior aspect of the superior ramus of the symphysis pubis. It runs along the posterior aspect of the superior pubic ramus and its laceration can prove life threatening in trauma cases or in scheduled operations.

CMOR is clinically important due to the potential risk of bleeding in pelvic fractures, pelvic and acetabular operations, surgery for urinary incontinence, oncologycal pelvic dissections and laparoscopic hernia repair. It requires special interests from different surgical branches, such as orthopedics, oncologic surgery, urogynecology and general surgery. Vascular anatomy of retropubic area, especially CMOR, should be kept in mind by surgeons performing laparoscopic surgery for hernia repair. In literature, the anatomical data have usually been come from studies performed on cadavers. The aim of this study was to provide in vivo knowledge about the presence, type (venous and/or arterial) and size of CMOR in patients who underwent TEP repair.

300 patients will undergo TEP procedure for unilateral or bilateral inguinal hernias. TEP procedures will be performed with three ports and one or three skin incisions. The presence and type of CMOR will be evaluated, and picture will be made. The size of the CMOR will be defined with ruler inserted true the 10 mm port.

• TEP (Procedure): Total extraperitoneal laparoendoscopic hernia repair with one or three skin incisions.

Primary outcomes

• Presence of CMOR [Intraoperative]: Evaluation of presence of Corona mortis in each hemipelvis examined. For unilateral hernias - one hemipelvis, in bilateral - two hemipelvices.
• Type CMOR [Intraoperative]: Evaluation of the type of Corona Mortis - Arterial, Venous or both types, in each hemipelvis
• Size of CMOR [Intraoperative]: Evaluation of size of Corona Mortis in mm., measured with ruler.
• Diameter of Corona Mortis Vessels [Intraoperatively, during retropubic dissection in the TEP procedure]: The diameter of each identified arterial and/or venous corona mortis vessel was measured intraoperatively in millimeters using a sterile ruler introduced through a 10-mm trocar. When more than one vessel was identified in the same hemipelvis, each vessel was measured and analyzed separately.

Sex: All, ages: 18 Years to 90 Years

Inclusion Criteria:

* Diagnosed primary or recurrence unilateral or bilateral inguinal hernia
* Age between 18 and 90;

Exclusion Criteria:

* Patients who prefer other surgical approach than TEP

Participant flow

Outcome results

• Presence of CMOR (Primary), Number, Hemipelves: Patients Undergoing TEP 229
• Type CMOR (Primary), Count of units, Hemipelves: Patients Undergoing TEP 28
• Size of CMOR (Primary), Count of units, Number or vessels: Patients Undergoing TEP 182
• Diameter of Corona Mortis Vessels (Primary), Mean, mm: Patients Undergoing TEP 2.42 +/- 1.44

Adverse events

Time frame: From the start to the end of the TEP procedure (intraoperative period only).

• Study Protocol (PDF, 2026-07-17)
• Statistical Analysis Plan (PDF, 2026-07-17)