Ilioinguinal Approach to Acetabulum

Ilioinguinal incision along the iliac crest and above the inguinal ligament towards the symphysis, with the deep exposure of the inner table
Ilioinguinal incision along the iliac crest and above the inguinal ligament towards the symphysis, with the deep exposure of the inner table and pelvic brim after iliopsoas and the external iliac vessels are retracted. Image from Hu X, Lu M, Wang J, Li L, Min L, Tu C. Combined and Modified Gibson and Ilioinguinal Approaches in Type II + III Internal Hemipelvectomy for Periacetabular Tumors. Front Oncol. 2022, 12, 934812. CC BY 4.0.
Ilioinguinal Approach to Acetabulum, structures passing behind the inguinal ligament
Structures passing behind the inguinal ligament. Image by Henry Gray, Wikimedia Commons, Public domain.

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

  • not for occasional surgeon
    • in conjunction with general surgeon
    • cadaveric dissection

Position

Landmarks

  • ASIS
  • Pubic 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 abdominis 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
  • 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

Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.