Yu Ohkura, Shusuke Haruta, Hisashi Shinohara, Seigi Lee, Yudai Fukui, Nao Kobayashi, Kota Momose, Masaki Ueno and Harushi Udagawa declare that we have no competing interests.
YO and SH contributed equally to this work; YO and SH designed the study, contributed new reagents and analytic tools, analyzed the data, and wrote the paper. YO drafted the article, revised it critically for important intellectual content, and gave final approval for the content; YO, SH, HS, SL, YF, NK, KM, MU and HU created study materials or recruited patients. All authors’ read and approved the final manuscript. All authors read and approved the final manuscript.
Inguinal hernias account for 75 % of abdominal wall hernias, with a lifetime risk of 27 % in men and 3 % in women. Major complications are recurrence, chronic pain, and surgical site infection, but their frequency is low. Few studies have reported a calcified mesh causing neuropathy by chronic compression of the femoral nerve after mesh & plug inguinal hernia repair. This is the first report of laparoscopic plug removal for femoral colic due to femoral nerve irritation cause by a calcified plug after mesh & plug inguinal hernia repair.
In July 2013, a 53-year-old man presented to our hospital with a chief complaint of colic pain in the left lower limb while walking. The patient had undergone left inguinal hernia repair about 10 years earlier and reported no chronic pain after the operation. Physical examination revealed a colic pain exacerbated by left thigh movement, especially during flexion, but the patient was pain-free at rest and had no sensory loss. Axial computed tomography and magnetic resonance imaging showed that the inward-projecting plug was extremely close to the femoral nerve. Because of the radicular symptoms and the absence of orthopedic and urological disease, we strongly suspected that the neuralgia was associated with the previous hernia operation and advised exploratory laparotomy, which revealed the plug bulging inward into the abdominal cavity. Moreover, the tip of the plug was firmly calcified and compressing the femoral nerve, which lay just beneath the plug, especially during hip flexion. We explanted the plug and his pain resolved after the operation. The patient remains pain free after 20 months of follow up.
In this study, laparoscopic hernioplasty proved useful for plug removal because laparoscopic instruments can easily grasp perilesional tissue, and laparoscopic approach has the benefit of isolating the plug for removal while preserving the onlay patch, and helpful for restoring peritoneal defects. Laparoscopic plug removal effectively resolved colic pain in the left thigh due to compression of the femoral nerve by a calcified plug.
Lichtenstein IL, Shulman AG. Ambulatory outpatient hernia surgery. Including a new concept, introducing tension-free repair. Int Surg. 1986;71:1–4. PubMed
Rutkow IM, Robbins AW. “Tension-free” inguinal herniarrhaphy: a preliminary report on the “mesh plug” technique. Surgery. 1993;114:3–8. PubMed
Robyn Mitchell G, Gardener RM, Boyd CR. Examining modern approaches to inguinal and femoral herniorrhaphy. JAAPA. 2008;21:39–41.
Donati M, Brancato G, Giglio A, Biondi A, Basile F, Donati A. Incidence of pain after inguinal hernia repair in the elderly. A retrospective historical cohort evaluation of 18-years’ experience with a mesh & plug inguinal hernia repair method on about 3000 patients. BMC Surg. 2013;13:S19. CrossRefPubMedPubMedCentral
Song JW, Wolf Jr JS, McGillicuddy JE, Bhangoo S, Yang LJ. Laparoscopic triple neurectomy for intractable groin pain: technical report of 3 cases. Neurosurgery. 2011;68:339–46. PubMed
Bachul P, Tomaszewski KA, Kratochwil M, Solecki R, Walocha JA. Anatomic variability of groin innervation. Folia Morphol. 2013;72:267–70. CrossRef
Celebi S, Aksoy D, Cevik B, Yildiz A, Kurt S, Dokucu AI. An electrophysiologic evaluation of whether open andlaparoscopic techniques used in pediatric inguinal herniarepairs affect the genitofemoral nerve. J Pediatric Surg. 2013;48:2160–3. CrossRef
Meyer A, Blanc P, Balique JG, Kitamura M, Juan RT, Delacoste F, et al. Laparoscopic totally extraperitoneal inguinal hernia repair. Twenty-seven serious complications after 4565 consecutive operations. Rev Col Bras Cir. 2013;40:032–6. CrossRef
Saleh F, Okrainec A, D’Souza N, Kwong J, Jackson TD. Safety of laparoscopic and open approaches for repair of the unilateral primary inguinal hernia: an analysis of short-term outcomes. Am J Surg. 2014;3.9:195–201. CrossRef
- Laparoscopic plug removal for femoral nerve colic pain after mesh & plug hernioplasty
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