Incidence of Corona Mortis during Endoscopic Extra-peritoneal Inguinal Hernia Repair at a Tertiary Centre

Abstract Background: Endoscopic inguinal hernia repair is one of the most common surgical procedures in modern day general surgery. However, the extra-peritoneal plane creation in the retro-pubic space makes this procedure quite challenging due to the involvement of the major vascular anastomosis. Corona Mortis, also known as the ‘crown of death’, is a vascular anastomosis between the obturator and external iliac or inferior epigastric vessels located behind the superior pubic ramus in the retropubic space. Our study aims to identify the incidence and anatomical characteristics of corona mortis at a tertiary care centre during endoscopic extra-peritoneal inguinal hernia repair. Materials and Methods: It was a prospective and observational study conducted on all patients above 18 years who underwent endoscopic extra-peritoneal inguinal hernia repair for 18 months after applying the exclusion criteria. We have studied the endoscopic observation of retro-pubic vascular anatomy in patients who underwent endoscopic extra-peritoneal inguinal hernia repair. Results: We found that the overall incidence of Corona Mortis during endoscopic extra-peritoneal inguinal hernia repair on either side or either has venous/arterial communication was approximately 68%. Corona Mortis was seen in 23% with arterial communication, 55% with venous communication and 18% with both arterial and venous communication. Conclusion: We conclude that the incidence of Corona Mortis is significantly higher in our study than in the literature. Moreover, the surgeon should be aware that it is a common anatomical variation while dissecting the retro pubic space/pelvic surgeries.