Robotic Spermatic Cord Lysis for Treatment of Post-Operative Chronic Testicular Pain after Laparoscopic TEP Inguinal Hernia Repair with Mesh

Erfan Zarrinkhoo, BA1, Shirin Towfigh, MD1, David Josephson, MD2. 1Beverly Hills Hernia Center, 2Tower Urology

Case: 52 year old male with a history of vasectomy undergoes laparoscopic TEP bilateral inguinal hernia repair with mesh. After initial recovery, he develops pain and feeling of tugging sensation of the left spermatic cord and testicle.

Hypothesis: Retroperitoneal mesh placement may cause postoperative symptoms affecting the spermatic cord, due to mesh-related adhesions.

Workup: The patient is found to have non-specific 3+ tenderness of the left spermatic cord at the external inguinal ring. He undergoes full evaluation for his postoperative pain, including nerve blocks, trigger point injections, ultrasound, MRI, and full urologic evaluation. His pain is deemed non-neuropathic and not related to hernia recurrence or postoperative infection. He also was ruled out for epididymitis and other urologic causes of spermatic cord pain.

Intervention: The patient underwent complete robotic-assisted retroperitoneal adhesiolysis of the spermatic cord. A segment of mesh was also excised off the cord structures.

Results: The patient had immediate and complete resolution of his pain. Upon 2-month follow-up, he remains symptom-free.

Conclusions: When performing laparoscopic inguinal hernia repair with mesh, there is an overlap of mesh with the retroperitoneal spermatic cord. This may cause spermatic cord immobilization due to adhesion, which is construed as pain and a tugging sensation radiating down towards the testicles.

Postoperative spermatic cord sensitivity and pain may be due to adhesions of the retroperitoneal mesh onto the spermatic cord. If the symptoms are debilitating, surgery should be considered to release the spermatic cord from the mesh and its surrounding tissues.

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