During laparoscopic inguinal hernia repair a tacker was accidently placed below and lateral to the ilio-pubic tract. Postoperatively the patient complained of pain and soreness in the thigh. This is due to the involvement of:
(A) Lateral cutaneous nerve of thigh (B) llioinguinal nerve (C) Genital branch of genitofemoral nerve (D) Obturator nerve
(A) Ans: A. Lateral cutaneous nerve of thigh(Ref Sabiston 19/e pink Schwaz 10/e p-1515, 9/e p1313-1315; Sehackelford 7/e p562-565)Neuropathic groin pain:Caused by damage to a nerve in the groin region and may he due to paial or complete division, stretching, contusion, crushing, suturing, or electrocautery.Nerves involved:Ilioinguinal nerve, iliohypogastric nerve, both the genital and femoral branches of the genitofemoral nerve, and the lateral femoral-1 cutaneous nerve of the thigh.1st two more prone to injury during an open herniorrhaphy.Latter (i.e. Lateral cutaneous nerve of thigh) are more likely damaged during laparoscopy.The genital and femoral branches of the genitofemoral nerve and the lateral cutaneous nerve of the thigh are most at risk when the surgeon staples below the iliopubic tract when lateral to the internal .spermatic vessels.A burning, tingling pain along the lateral aspect of the thigh in the distribution of the lateral femoral cutaneous nerve is known as meralgia parestheticaDue to entrapment of that nerve.Affected skin area:Hyperaesthetic and/or pruritic.Complain of tactile hallucination of a sensation of small insects creeping under the skin (formication).