ROLE OF SURGICAL ANATOMY IN PRESERVATION OF REGIONAL NERVES IN PREVENTING POST HERNIOPLASTY INGUINODYNIA

Dr. Wasi Abbas Rizvi; Dr. Deepshikha Chaudhary

Volume : IX, Issue : I, January - 2019

ROLE OF SURGICAL ANATOMY IN PRESERVATION OF REGIONAL NERVES IN PREVENTING POST HERNIOPLASTY INGUINODYNIA

Dr. Wasi Abbas Rizvi, Dr. Deepshikha Chaudhary

Abstract :

Post inguinal Hernioplasty inguinodynia (ranges from mild moderate to severe pain with a variable aetiology (somatic/visceral/ neuropathic/nociceptive/ psychological) and is often a rare complaint of the patient who have undergone Lichtenstein tension free mesh Hernioplasty which is noted either in immediate post operative period or in subsequent follow up post operatively as a chronic pain entity. In immediate post operative period it can be caused by acute inflammatory response, meshoma, nerve injury or intraoperatively nerve entrapment and mesh adherence by fiosis, where as in regular follow up at 1 week , 2 week or at 3– 4 weeks or even delayed up to 12 or more weeks post operatively it can be due to causes like neuropathy, hernial recurrence or due to regional inguinal nerve injury or scarring. The symptom of type of pain is variable to a great extent therefore the actual cause of pain with which the patient presents makes both diagnosis and treatment challenging. A cohort of 30 patients (n=30) who have undergone open inguinal mesh Hernioplasty (A modified Lichtenstein tension free repair was done using polypropylene mesh) for left / right inguinal hernia (direct/indirect ) and were observed post operatively and on follow up at surgical out door, for any post operative complications including for complaint of inguinodynia post operatively at 1/2/3/4 week interval respectively. A total of 2 patients presented with post operative complications. Of which 1 patients developed immediate post operative complication of meshoma causing inguinodynia, managed post operatively with single skin stitch removal and evacuation without re exploration along with post operative intravenous medication and oral anti–inflammatory medication. On discharge and on regular follow up he was asymptomatic. The second patient developed single stitch line infection which was managed conservatively without a need of re–exploration. No patient had inguinodynia after 3 week on follow up postoperatively. Understanding the gross and neuro–anatomy of the inguinal region, tissue respect and meticulous dissection is of great value in preventing nerve injury /scarring or nerve entrapment intraoperatively and taking a prompt notice of any post operative complication including inguinodynia of variable aetiology in immediate or in follow up is must improving the outcome post operatively in patients undergoing inguinal mesh Hernioplasty. Article keywords: Inguinal canal, Inguinal neuroanatomy, Illio inguinal nerve (IIN),,Illio hypogastric nerve (IHN),Genito femoral nerve (GFN),Lichtenstein tension free mesh repair, Femoral nerve (FN), Obturator nerve( ON)