The cutaneous nerves encountered during laparoscopic repair of inguinal hernia: new anatomical findings for the surgeon.
BACKGROUND
With an incidence rate of 2%, injury to the nerves of the lumbar plexus is the most common complication of laparoscopic hernioplasty, particularly when the transabdominal preperitoneal (TAPP) technique is used.


METHODS
The course of the genitofemoral nerve, lateral femoral cutaneous nerve, and ilioinguinal nerve within the operation site was investigated in 53 adult dissecting-room bodies. Their relationship to the deep inguinal ring, iliopubic tract, and anterior superior iliac spine was also examined.


RESULTS
Both the femoral and genital branches of the genitofemoral nerve may penetrate the abdominal wall lateral to the deep ring and cranial to the iliopubic tract. The lateral femoral cutaneous nerve and the ilioinguinal nerve may run immediately lateral to the anterior superior iliac spine.


CONCLUSIONS
Contrary to the previously accepted opinion, dissection and the placement of staples either cranial to the iliopubic tract or lateral to the anterior superior iliac spine can result in injury to the nerves.
Rosenberger
R J
RJ
Department of Anatomy, Ludwig Maximilian University, Pettenkoferstrasse 11, D-80336 Munich, Germany.
Loeweneck
H
H
Meyer
G
G
D000328:Adult; D005267:Femoral Nerve / Q000293:injuries*; D006552:Hernia, Inguinal / Q000601:surgery*; D006801:Humans; D007264:Inguinal Canal / Q000033:anatomy & histology / Q000294:innervation*; D007431:Intraoperative Complications / Q000517:prevention & control