1/33. Tack entrapment of the ilioinguinal nerve during laparoscopic hernia repair.Nerve injury has a reported incidence of 2% during laparoscopic hernia repair. These injuries usually involve the femoral branch of the genitofemoral nerve and the lateral cutaneous nerve of the thigh. Recently, in an effort to decrease the size of the port sites, surgeons have been using 5-mm tacking devices. These devices penetrate tissue more deeply and in so doing may injure nerves not classically at risk, such as the ilioinguinal and the iliohypogastric. We report the first documented injury to the ilioinguinal nerve during laparoscopic hernia repair. In addition, we review the anatomy and technique in an effort to help avoid this complication in the future.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
2/33. Laparoscopic management of spermatic cord entrapment after laparoscopic inguinal herniorrhaphy.spermatic cord entrapment is an unusual complication of inguinal herniorrhaphy. The case of a 52-year-old man who presented with severe pain along the left spermatic cord and testicle, varicocele, and dyspareunia after a laparoscopic bilateral inguinal hernia repair performed elsewhere is reported. Medical treatment failed, and laparoscopic exploration showed the vas deferens and spermatic vessels entrapped by a mesh slit that was pulling the genital branch of the genitofemoral nerve. The vas deferens and spermatic vessels were released, neurotomy of the affected nerve branch was performed, and a new mesh was positioned in the residual space. The patient's pain disappeared completely after the surgery and the varicocele decreased progressively. The patient remains asymptomatic at 1-year follow-up. laparoscopy might be the approach of choice to treat some of the complications of laparoscopic hernia repair, not only because it allows better observation of the anatomic structures, but also because the surgical therapy can be done with minimal tissue damage compared to the traditional approach.- - - - - - - - - - ranking = 0.25keywords = nerve (Clic here for more details about this article) |
3/33. Treatment of inguinodynia after laparoscopic herniorrhaphy: a combined laparoscopic and fluoroscopic approach to the removal of helical tackers.Laparoscopic inguinal herniorrhaphy has become a popular operation for the treatment of inguinal hernia. However, injury and entrapment of the cutaneous nerves of the lumbar plexus by the staples or tackers used for mesh fixation have been described. Laparoscopic removal of the staples or tackers in the inguinal region has been attempted with variable success. The success of the laparoscopic approach for removal of helical tackers in particular is sometimes limited by the fact that the offending tackers are deeply embedded in the preperitoneal tissues and not readily located with a simple laparoscopic view. The authors report a case in which fluoroscopy was used to help identify tackers that could not be visualized laparoscopically. The neuralgia disappeared after successful removal of the offending tackers with no neurologic deficit. Liberal use of fluoroscopic guidance in the laparoscopic removal of helical tackers in similar cases is recommended.- - - - - - - - - - ranking = 0.125keywords = nerve (Clic here for more details about this article) |
4/33. Acute hemoperitoneum caused by rupture of omentum adhesions after running.The case of a 37-year-old man in whom a massive hemoperitoneum developed a few hours after running is described. The patient disclaimed any trauma and clearly noted that symptoms appeared after running. Findings at laparoscopy showed that the bleeding was caused by the rupture of adhesions between the omentum and left inguinal abdominal wall. These adhesions, which had resulted from a previous laparoscopic transperitoneal bilateral inguinal hernia cure, were resected. Recovery was simple and follow-up assessment was uneventful. hemoperitoneum secondary to the rupture of intraperitoneal adhesions is very rare in the absence of precipitating trauma. However, the trauma can be trivial. rupture of intra-abdominal adhesions has been described after sexual intercourse or mobilization of the patient under general anesthesia. Disruption of adhesions by insufflation or mobilization of organs under laparoscopy also is reported. The transperitoneal approach to laparoscopic treatment of inguinal hernia can be responsible for late intestinal obstruction caused by intra-abdominal adhesions, but late hemorrhagic complication has not yet been reported.- - - - - - - - - - ranking = 0.0062215402208582keywords = organ (Clic here for more details about this article) |
5/33. A rare case of pseudomyxoma peritonei presenting an unusual inguinal hernia and splenic metastasis.pseudomyxoma peritonei (PMP) is a rare clinical entity in which a diffuse collection of intraperitoneal gelatinous fluid is associated with gelatinous implants on the peritoneal surfaces and omentum. Hematogenic or lymphatic metastasis is extremely rare. In addition, an inguinal mass as an initial presentation is also relatively rare. This is a case report of a PMP patient who had splenic metastasis and showed an inguinal tumor as an initial presentation. A 59-year-old female patient, who had undergone bilateral oophorectomy because of a ruptured ovarian mucinous tumor of boderline malignancy 12 years previously, presented a presumptive diagnosis of a left inguinal irreducible hernia. Computed tomography revealed a low density mass in the pelvic cavity and in the inguinal lesion, as well as in the spleen without any diseases around the organ. The preoperative serum carcinoembryonic antigen (CEA) level was elevated. The patient underwent a resection of gelatinous tumor in the pelvic cavity, splenectomy, and appendectomy, as well as left inguinal herniorrhaphy. Histological examinations revealed a splenic metastasis of PMP originating from the ovarian low-grade mucinous tumor. She received postoperative intraperitoneal lavage as well as chemotherapy, and has survived for over 7 years postoperatively without any evidence of recurrence, as confirmed by repeated follow-up CT examinations and CEA determination. Splenic metastasis of PMP is extremely rare; this represents only the third reported case of its kind in the literature. Furthermore, it should be noted that an inguinal tumor can sometimes be an initial presentation of PMP.- - - - - - - - - - ranking = 0.0062215402208582keywords = organ (Clic here for more details about this article) |
6/33. Separation of xiphi-omphalo-ischiopagus tetrapus twins with favorable internal anatomy.Conjoined twinning is a rare occurrence, and ischiopagus variety is even more rare. So far, only 20 cases have been reported. The incidence is 1 in 500,000. Because of its rarity and variable anatomy, no definite line of treatment can be adapted. time of operation and mode of treatment have to be tailored according to the local circumstances and organ sharing in each individual pair. The twins in this report were xi phi-omphalo-ischiopagus tetrapus conjoined twins. Although several internal organs were fused and shared, they were complete mirror image sets for each twin. In this case report, details of anatomy and more importantly, preoperative investigations, preparations, and organizational aspects that were designed to suit local conditions are described. Operative details, postoperative care, and short and long-term progress also has been highlighted.- - - - - - - - - - ranking = 0.018664620662575keywords = organ (Clic here for more details about this article) |
7/33. Is ilioinguinal/iliohypogastric nerve block always totally safe in children?We report a case of accidental puncture of the small bowel during an ilioinguinal/iliohypogastric nerve block procedure for hernia repair. The diagnosis was made a few days later during a laparoscopic exploration owing to the progressive onset of clinical and radiological intestinal obstruction. A large, obstructing subserosal haematoma was found without any apparent perforation of the mucosa, and the damaged loop was resected. Such a complication has already been reported once in the literature after use of a long bevel needle for the puncture. This case is the first reported using an atraumatic short bevel needle. We discuss the technical aspects of the procedure and underline the fact that regional anaesthesia in children is never totally risk free.- - - - - - - - - - ranking = 0.625keywords = nerve (Clic here for more details about this article) |
8/33. Pulsed radiofrequency as a treatment for groin pain and orchialgia.Inguinal and testicular pain are challenging problems for which no reliable, standardized treatment exists. We report 3 patients with groin pain or orchialgia who were treated with pulsed radiofrequency of the nerves innervating these areas. All 3 patients reported complete pain relief at their 6-month follow-up visits. The techniques and settings used for the nerve blocks and radiofrequency procedures are explained in detail, along with a brief synopsis of the rationale for using it. Randomized, placebo-controlled studies are needed to better assess the efficacy of this procedure and identify eligible candidates.- - - - - - - - - - ranking = 0.25keywords = nerve (Clic here for more details about this article) |
9/33. paralysis of the femoral nerve following totally extraperitoneal laparascopic inguinal hernia repair.Totally extraperitoneal preparation (TEP) of an inguinal hernia is an established method of treating inguinal hernias associated with an acceptable complication rate (2-12%) and low rate of recurrence (0-3%). This is the first reported case of sensorimotor paralysis of the femoral nerve following the complete endoscopic mesh treatment of a primary inguinal hernia to the left side. Following a discussion of the necessary diagnostic and therapeutic steps, traumatic postsurgical paralysis of the nerve as well as spontaneous paralysis of the femoral nerve are discussed. The prognosis is positive given the lack of macroscopic evidence of any direct damage to the nerve.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
10/33. Schwannoma in the inguinal canal masquerading an inguinal hernia.Benign neoplasms originating from the neuronal sheath are usually found along the distribution of the cranial nerves and in the flexor surfaces of the upper and lower extremities. We herein present a case of a 65-year-old man with a schwannoma located in the inguinal canal, which presented as an irreducible hernia. This is the first reported case in the English literature of a schwannoma with such a presentation.- - - - - - - - - - ranking = 0.125keywords = nerve (Clic here for more details about this article) |
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