TEP opertion performed in chronic inguinal neuralgia

Takayuki Iino, MD

Division of Gastroenterolgical Surgery, Department of Surgery, Yachiyo Medical Center, Tokyo Women’s Medical University

We encounter groin pain and inguinal hernia in daily practice, but there are times where poor clinical findings makes it difficult. Chronic inguinal neuralgia without herniation is one of them. Prophylactic ilioinguinal neurectomy, routine ilioinginal nerve excision, and sometimes nerve blocks have been done in the past. In 2009, the guide line of Europe hernia society was published and total extraperitoneal (TEP) technique was recommended as level A. Knowledge of the posterior approach and clear understanding of the endoscopic anatomy of inguinal region made possible to preserve iliohypogastric nerve and ilioinguinal nerve under closeup view of laparoscopy.

Materials and methods
We performed inguinal hernia repairs to 389 cases in past 5 years since our hospital was established. To preserve inguinal canal throughout the operation, posterior approach was performed to 158 cases and laparoscopic operation was done to 153 cases. Routine abdominal CT examination is done in most cases for preoperative evaluation. 3 cases with poor clinical findings with severe chronic inguinal neuralgia were successfully operated by TEP.

First case is 67 years-old male came to the hospital with groin pain which often occur in the night time. Preoperative examination showed no inguinal hernia but resulted in bowel herniation at the night time which was causing the groin pain. Second case was 57 years-old female who previously had hospital visit with gynecological disease. Preoperative examination again showed no inguinal hernia and CT exam was also negative. After full explanation and consent by the patient, we operated TEP. The compression by the lipoma near the ilioinguinal nerve was causing the groin pain. After the removal of lipoma, groin pain disappeared with no recurrence. Third case was 17 years-old male who hopes to be a professional baseball player. He has visited five different hospitals previously including orthopedic. He had no herniation and preoperative CT scan showed no apparent abnormalities. With regard to symptoms, the close interview was done. The compression of ilioinguinal nerve by the enlarged lymph nodes was seen under the laparoscopic view. He was able to return to prior training program without groin pain, two weeks after the operation.

Laparoscopic view and the posterior approach made possible to treat some of the incomprehensible groin pain in the past.

Session: Poster Presentation

Program Number: P303

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