The medial umbilical ligaments are paired fibrous remnants of the umbilical arteries, which in the fetus carried deoxygenated blood from the internal iliac arteries to the placenta. After birth, the umbilical arteries obliterate from the umbilicus proximally, leaving fibrous cords covered by the medial umbilical folds of peritoneum on the anterior abdominal wall, converging from the lateral pelvic walls toward the umbilicus.
Vestigial structures with no vascular function in adults; serve as laparoscopic orientation landmarks flanking the median umbilical fold and as posterior boundaries of the prevesical space of Retzius.
The medial umbilical folds and their ligaments are important landmarks in laparoscopic pelvic surgery, where the medial umbilical ligament forms the medial boundary of the paravesical fossa and the lateral boundary of the space of Retzius. Division of the medial umbilical ligament provides access to the paravesical and prevesical spaces in laparoscopic sacrocolpopexy, radical cystectomy, and prostatectomy. In laparoscopic inguinal hernia repair, the medial umbilical fold must be identified to avoid inadvertent inclusion in the mesh.
The medial umbilical ligament is the medial boundary of the paravesical fossa encountered in laparoscopic pelvic surgery; division medial to the ligament enters the space of Retzius and the retropubic space, while division lateral preserves the ligament and accesses the paravesical space for iliac vessel and lymph node dissection.
