Ilioinguinal neuralgia following laparoscopic inguinal hernia repair
Ilioinguinal neuralgia following laparoscopic inguinal hernia repair --> note (i) the typical location of nerve swelling and maximal irritability to direct probing, which is superolateral to deep inguinal ring and corresponds with the area in which the nerve has just left its course through the non-meshed abdominal wall and is now passing over the most lateral segment of the mesh; and (ii) the lack of any nerve encasement by scar or direct impingement by sutures or any other form of surgical fixation. I have a large experience now with cases like this and, although the ilioinguinal nerve can indeed occasionally be directly entrapped/impinged, most have an appearance similar to this one --> I have therefore come to think that neuralgia in these post-surgical settings is most often a functional irritation that reflects nerve stretch arising from physical activities on the potentiating background of now passing over the margin of a now rigidified/stiffer abdominal wall segment due to mesh. This might also account for the occasional case that I see where the patient has been relatively symptom-free for some time after surgery (even years) before suddenly becoming symptomatic after either (a) an episode of excessive or particularly provocative physical activity, or (b) a discrete injury.
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