Ilioinguinal approach to acetabulum

Indications

exposure of inner surface of pelvis from the sacroiliac joint to pubic symphysis
anterior & medial surfaces of acetabulum

Contraindications

does not expose articular surface of acetabulum

Principles

no for occasional surgeon
- in conjunction with general surgeon
- cadaveric dissection

Position

supine with greater trochanter at edge of table
IDC

Landmarks

ASIS
Public tubercles

Incision

Curved anterior incision
Start: 5cm above the ASIS extending medially passing 1 cm above the pubic tubercle
End: midline

Superficial Dissection

Dissect through subcutaneous fat in line of the skin incision to expose the aponeurosis of external oblique muscle
Lateral Cutaneous Nerve of Thigh appears at the lateral edge of the wound & will need to be divided
Divide
- Aponeurosis of external oblique muscle from superficial inguinal ring to ASIS
  - This exposes spermatic cord / round ligament
  - Isolate these structures in a sling
- Anterior part of rectus sheath
  - Exposes rectus abdominis

Deep Dissection

Divide rectus abdominal muscle transversely 1 cm proximal to its insertion
Develop a plane using blunt dissection (finger) between pubic symphysis & bladder
Divide internal oblique & transversus abdominus muscles that form the posterior wall of inguinal canal
- Ligate the inferior epigastric artery at the medial edge of deep inguinal ring
Exposes the peritoneum & extraperitoneal fat
Elevate the peritoneum upwards to reveal
- Femoral vessels
- Femoral nerve
- Tendon of iliopsoas
Isolate these structures & protect with sling, retract medially
Dissect iliacus off iliac wing
Exposes the medial surface of acetabulum & superior pubic ramus

Dangers

Nerve
- Femoral
- Lateral cutaneous nerve of thigh
Vessels
- Femoral
- Inferior epigastric artery & vein
Spermatic cord
Bladder