Nerve irritation after laparoscopic hernia repair

Area of Science:

• General Surgery
• Minimally Invasive Surgery
• Abdominal Surgery

Background:

• A retrospective analysis of 893 hernia repairs performed between 1992 and 1996.
• 50% (448) utilized laparoscopic transabdominal preperitoneal (TAPP) repair, while 50% (445) used the conventional anterior (Shouldice) approach.

Purpose of the Study:

• To prospectively evaluate postoperative nerve irritations following laparoscopic (TAPP) versus conventional anterior hernia repair.
• To identify the incidence and types of nerve entrapment in different hernia repair techniques.

Main Methods:

• Prospective follow-up of 723 (81%) patients who underwent hernia repair.
• Comparison of nerve entrapment rates between TAPP and conventional anterior repair groups.
• Detailed analysis of affected nerves, including genitofemoral, ilioinguinal, and lateral cutaneous nerve of the thigh (LCNT).

Main Results:

• The laparoscopic TAPP group had a significantly higher rate of nerve entrapment (4.2%) compared to the conventional anterior group (1.8%).
• The genitofemoral nerve was most frequently affected (2%), followed by the ilioinguinal nerve (1.1%) and LCNT (1.1%).

Conclusions:

• Nerve entrapment is a notable complication of laparoscopic hernia repair, particularly affecting specific nerves.
• Refined surgical techniques, including minimizing clip usage and respecting nerve anatomy during mesh placement, can reduce nerve irritation.
• Improvements in technique led to a substantial decrease in nerve lesions in the last 100 laparoscopic cases, with only one instance observed.