Cases reported "Hernia, Inguinal"

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1/36. Tack entrapment of the ilioinguinal nerve during laparoscopic hernia repair.

    Nerve injury has a reported incidence of 2% during laparoscopic hernia repair. These injuries usually involve the femoral branch of the genitofemoral nerve and the lateral cutaneous nerve of the thigh. Recently, in an effort to decrease the size of the port sites, surgeons have been using 5-mm tacking devices. These devices penetrate tissue more deeply and in so doing may injure nerves not classically at risk, such as the ilioinguinal and the iliohypogastric. We report the first documented injury to the ilioinguinal nerve during laparoscopic hernia repair. In addition, we review the anatomy and technique in an effort to help avoid this complication in the future.
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ranking = 1
keywords = nerve
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2/36. Pneumomediastinum, pneumothorax and subcutaneous emphysema complicating MIS herniorrhaphy.

    PURPOSE: Videoscopic herniorrhaphy is being performed more frequently with advantages claimed over the conventional open approach. This clinical report describes a pneumothorax, pneumomediastinum and subcutaneous emphysema occurring at the end of an extraperitoneal videoscopic herniorrhaphy. CLINICAL FEATURES: A 25 yr old ASA I man presented for elective extraperitoneal videoscopic hernia repair. Following intravenous induction with fentanyl, midazolam and propofol a balanced anesthetic technique using enflurane in N2O and O2 was used. Apart from a prolonged operating time (195 min), the procedure and anesthetic was uneventful. At the conclusion of the operation, prior to reversal of neuromuscular blockade extensive subcutaneous emphysema was noted on removal of the surgical drapes. Chest radiography revealed a pneumomediastinum and pneumothorax. A 25 FG intercostal tube was inserted and connected to an underwater seal drain. Sedation and positive pressure ventilation was maintained overnight to permit resolution and avoid airway compromise. The clinical and radiological features had resolved by the next morning and the patient's trachea was extubated. His subsequent recovery was uneventful. CONCLUSION: pneumothorax and pneumomediastinum are well recognised complications of laparoscopic techniques but have not been described following extraperitoneal herniorrhaphy. In this report we postulate possible mechanisms which may have contributed to their development, including inadvertent breach of the peritoneum and leakage of gas around the diaphragmatic herniae or tracking of gas retroperitoneally. The case alerts us to the possibility of this complication occurring in patients undergoing videoscopic herniorrhaphy.
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ranking = 0.21743637237274
keywords = block
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3/36. Can a dose of 2microg.kg(-1) caudal clonidine cause respiratory depression in neonates?

    A case of multiple life-threatening postoperative apnoeas in a term neonate undergoing inguinal herniorrhaphy and orchidopexy who received light inhalation anaesthesia combined with caudal block with 1 ml.kg-1 ropivacaine 0.2% plus 2 microg.kg-1 clonidine is reported. The patient showed no apparent risk factors for postanaesthetic apnoea. Oxycardiorespirography five days after surgery only showed minor abnormalities. clonidine though administered caudally in the usual dose of 2 microg.kg-1 appeared to be the most likely cause for postanaesthetic apnoea in this neonate.
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ranking = 0.21743637237274
keywords = block
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4/36. Laparoscopic management of spermatic cord entrapment after laparoscopic inguinal herniorrhaphy.

    spermatic cord entrapment is an unusual complication of inguinal herniorrhaphy. The case of a 52-year-old man who presented with severe pain along the left spermatic cord and testicle, varicocele, and dyspareunia after a laparoscopic bilateral inguinal hernia repair performed elsewhere is reported. Medical treatment failed, and laparoscopic exploration showed the vas deferens and spermatic vessels entrapped by a mesh slit that was pulling the genital branch of the genitofemoral nerve. The vas deferens and spermatic vessels were released, neurotomy of the affected nerve branch was performed, and a new mesh was positioned in the residual space. The patient's pain disappeared completely after the surgery and the varicocele decreased progressively. The patient remains asymptomatic at 1-year follow-up. laparoscopy might be the approach of choice to treat some of the complications of laparoscopic hernia repair, not only because it allows better observation of the anatomic structures, but also because the surgical therapy can be done with minimal tissue damage compared to the traditional approach.
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ranking = 0.25
keywords = nerve
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5/36. An alternative for avoidance of general anaesthesia for infants when bilateral inguinal herniorrhaphy outlasts subarachnoid blockade.

    Former premature infants represent a high risk surgical population. In order to minimize the risk of postoperative apnoea, subarachnoid blockade without sedation is known to be preferable to general anaesthesia for former premature infants undergoing bilateral inguinal herniorrhaphy. However, subarachnoid blockade affords only a limited duration of reliable anaesthesia. Nonroutine surgical delays and technical difficulties cannot always be anticipated by the anaesthesiologist. When bilateral inguinal herniorrhaphy outlasts the anticipated duration of subarachnoid blockade, the anaesthesiologist is confronted with a dilemma. Infants are unable to complain verbally, so the extent of subarachnoid blockade may be difficult to assess intraoperatively. Introduction of sedation or general anaesthesia under these circumstances increases the risk of postoperative apnoea, thereby defeating the purpose of the original choice of anaesthesia. Several alternatives have been proposed, but all involve disadvantages. In this report of two cases, a new solution to this clinical dilemma is presented.
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ranking = 1.739490978982
keywords = block
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6/36. Treatment of inguinodynia after laparoscopic herniorrhaphy: a combined laparoscopic and fluoroscopic approach to the removal of helical tackers.

    Laparoscopic inguinal herniorrhaphy has become a popular operation for the treatment of inguinal hernia. However, injury and entrapment of the cutaneous nerves of the lumbar plexus by the staples or tackers used for mesh fixation have been described. Laparoscopic removal of the staples or tackers in the inguinal region has been attempted with variable success. The success of the laparoscopic approach for removal of helical tackers in particular is sometimes limited by the fact that the offending tackers are deeply embedded in the preperitoneal tissues and not readily located with a simple laparoscopic view. The authors report a case in which fluoroscopy was used to help identify tackers that could not be visualized laparoscopically. The neuralgia disappeared after successful removal of the offending tackers with no neurologic deficit. Liberal use of fluoroscopic guidance in the laparoscopic removal of helical tackers in similar cases is recommended.
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ranking = 0.125
keywords = nerve
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7/36. Is ilioinguinal/iliohypogastric nerve block always totally safe in children?

    We report a case of accidental puncture of the small bowel during an ilioinguinal/iliohypogastric nerve block procedure for hernia repair. The diagnosis was made a few days later during a laparoscopic exploration owing to the progressive onset of clinical and radiological intestinal obstruction. A large, obstructing subserosal haematoma was found without any apparent perforation of the mucosa, and the damaged loop was resected. Such a complication has already been reported once in the literature after use of a long bevel needle for the puncture. This case is the first reported using an atraumatic short bevel needle. We discuss the technical aspects of the procedure and underline the fact that regional anaesthesia in children is never totally risk free.
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ranking = 60.612881391658
keywords = nerve block, block, nerve
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8/36. Pulsed radiofrequency as a treatment for groin pain and orchialgia.

    Inguinal and testicular pain are challenging problems for which no reliable, standardized treatment exists. We report 3 patients with groin pain or orchialgia who were treated with pulsed radiofrequency of the nerves innervating these areas. All 3 patients reported complete pain relief at their 6-month follow-up visits. The techniques and settings used for the nerve blocks and radiofrequency procedures are explained in detail, along with a brief synopsis of the rationale for using it. Randomized, placebo-controlled studies are needed to better assess the efficacy of this procedure and identify eligible candidates.
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ranking = 12.247576278332
keywords = nerve block, block, nerve
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9/36. paralysis of the femoral nerve following totally extraperitoneal laparascopic inguinal hernia repair.

    Totally extraperitoneal preparation (TEP) of an inguinal hernia is an established method of treating inguinal hernias associated with an acceptable complication rate (2-12%) and low rate of recurrence (0-3%). This is the first reported case of sensorimotor paralysis of the femoral nerve following the complete endoscopic mesh treatment of a primary inguinal hernia to the left side. Following a discussion of the necessary diagnostic and therapeutic steps, traumatic postsurgical paralysis of the nerve as well as spontaneous paralysis of the femoral nerve are discussed. The prognosis is positive given the lack of macroscopic evidence of any direct damage to the nerve.
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ranking = 1
keywords = nerve
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10/36. Schwannoma in the inguinal canal masquerading an inguinal hernia.

    Benign neoplasms originating from the neuronal sheath are usually found along the distribution of the cranial nerves and in the flexor surfaces of the upper and lower extremities. We herein present a case of a 65-year-old man with a schwannoma located in the inguinal canal, which presented as an irreducible hernia. This is the first reported case in the English literature of a schwannoma with such a presentation.
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ranking = 0.125
keywords = nerve
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