Femoral Nerve Paralysis Following Open Inguinal Hernia Repair

Stephen Larson¹, Ray Laird^1, and Fred Brody¹

¹The Department of Surgery, The George Washington University, Pennsylvania Ave, Washington, DC

Cite this paper

Stephen Larson, Ray Laird and Fred Brody. Femoral Nerve Paralysis Following Open Inguinal Hernia Repair. American Journal of Medical Case Reports. 2015; 3(3):85-87. doi: 10.12691/AJMCR-3-3-9

Abstract

Open inguinal hernia repair remains the gold standard to treat inguinal hernias and is associated with a low recurrence and complication rate [1,2,3,4]. The majority of inguinal hernia repairs are completed on an outpatient basis. Local, spinal, epidural, and general endotracheal anesthesia are used depending on patient comorbidities and surgeon preference. Overall, patient recovery is relatively quick and patients return to their normal activities in approximately four weeks. Complications may include hematoma, seroma, chronic groin pain, surgical site infection, and injury to adjacent organs. Femoral nerve injury may occur but is an exceedingly rare event following an open inguinal hernia repair. This manuscript details a patient with a transient sensorimotor paralysis of the femoral nerve following an open inguinal hernia repair. Various etiologies are discussed along with a review of the literature.

Keywords

inguinal hernia repair, femoral nerve paralysis, inguinal hernia complications, local anesthetic complications

Copyright

This work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References

[1]	Amato B, Moja L, Panico S, Persico G, Rispoli C, Rocco N, Moschetti I. (2012). Shouldice technique versus other open techniques for inguinal hernia repair. Cochrane Database Syst Rev. 4:CD001543.
[2]	Awad S, Fagan S. (2004). Current approaches to inguinal hernia repair. Am J Surg. 188(6a suppl):9S-16S.
[3]	Nilsson H, Stylianidis G, Haapamaki M, Nilsson E, Nordin P. (2007). Mortality after groin hernia surgery. Ann Surg. 245(4): 656-60.
[4]	Bittner R, Sauerland S, Schmedt C. (2005). Comparison of endoscopic techniques vs Shouldice and other open nonmesh techniques for inguinal hernia repair: a meta-analysis of randomized controlled trials. SurgEndosc. 19(5): 605-15.
[5]	Bittner R, Schwarz J. (2012). Inguinal hernia repair: current surgical techniques.Langenbeck's Arch Surg. 397(2): 271-82.
[6]	Read RC. (2009). Herniology: past, present, and future. Hernia 13(6): 577-80.
[7]	Amid PK. (2005). Groin hernia repair: open techniques. World J Surg. 29(8):1046-51.
[8]	CampanelliG, Canziani M, Frattini F, Cavalli M, Agrusti S.(2008).Inguinal hernia: state of the art.Int J Surg.6 Suppl 1:S26-8.
[9]	Arvidsson D, Berndsen F, Larsson L, Leijonmarck C, Rimback G, Rudberg C, Smedberg S, Spangen L, Montgomery A. (2005). Randomized clinical trial comparing 5-year recurrence rate after laparoscopic versus Shouldice repair of primary inguinal hernia. Br J Surg. 92(9): 1085-91.
[10]	Kraus MA. (1993). Nerve injury during laparoscopic inguinal hernia repair. SurgLaparoscEndosc. 3(4): 342-5.
[11]	Moore A, Stringer M. (2011). Iatrogenic femoral nerve injury: a systematic review.SurgRadiol Anat. 33(8): 649-58.
[12]	Naroji S, Belin L, Maltenfort M, Vaccaro A, Schwartz D, Harrop J, Weinstein M. (2009). Vulnerability of the femoral nerve during complex anterior and posterior spinal surgery.J Spinal Cord Med. 32(4):432-5.
[13]	Bohrer J, Walters M, Park A, Polston D, Barber M. (2009). Pelvic nerve injury following gynecologic surgery: a prospective cohort study. Am J Obstet Gynecol. 201(5):531.e1-7.
[14]	Natelson SE. (1997). Surgical correction of proximal femoral nerve entrapment.Surg Neurol. 48(4):326-9.
[15]	Lange B, Langer C, Markus P, Becker H. (2003). Paralysis of the femoral nerve following totally extraperitoneal laparoscopic inguinal hernia repair. SurgEndosc. 17(7):1157.
[16]	Keating J, Morgan A. (1993). Femoral nerve palsy following laparoscopic inguinal herniorrhaphy. J Laparoendosc Surg. 3(6): 557-9.
[17]	Berliner S. (1989). Accidental femoral nerve block during local anaesthesia for inguinal hernia repair.Anaesthesia. 44(3):261.
[18]	Rosario D, Jacob S, Luntley J, Skinner P, Raftery A. (1997). Mechanism of femoral nerve palsy complicating percutaneous ilioinguinal field block.Br J Anaesth. 78(3): 314-6.
[19]	Ghani K, McMillan R, Paterson-Brown S. (2002). Transient femoral nerve palsy following ilio-inguinal nerve blockade for day case inguinal hernia repair. J R CollSurgEdinb. 47(4): 626-9.
[20]	Hu D, Onel E, Singla N, Kramer W, Hadzic A. (2013). Pharmacokinetic profile of liposome bupivacaine injection following a single administration at the surgical site.Clin Drug Investig. 33(2): 109-15.