Lange J F M, Wijsmuller A R, van Geldere D, Simons M P, Swart R, Oomen J, Kleinrensink G J, Jeekel J, Lange J F
Department of Surgery, Isala Klinieken, Zwolle, The Netherlands.
Br J Surg. 2009 Oct;96(10):1210-4. doi: 10.1002/bjs.6698.
Inguinal nerve identification during open inguinal hernia repair is associated with less chronic postoperative pain. However, most Dutch surgeons do not identify all three inguinal nerves when carrying out this procedure. The aim of this study was to evaluate the feasibility of a nerve-recognizing Lichtenstein hernia repair and to measure the extra time required for surgery
Forty patients with primary inguinal hernia were operated on following the nerve-recognizing Lichtenstein hernia repair by four experienced hernia surgeons from four different Dutch teaching hospitals. The additional time needed to identify each individual nerve was recorded, and iatrogenic nerve injuries and anatomical characteristics were registered.
Identification of the iliohypogastric and ilioinguinal nerves was each performed within 1 min. Identification of the genital branch of the genitofemoral nerve was notably more difficult but could usually be performed within 2 min. Identification of the cremasteric vein, running parallel to the genital branch, was less comprehensive. The incidence of major anatomical variations was low. Twenty-five per cent of ilioinguinal nerves, however, could not be identified. In five patients inguinal nerves were damaged iatrogenically during standard manoeuvres of the Lichtenstein hernia repair.
Three-nerve-recognizing Lichtenstein hernia repair is feasible and non-time consuming if the surgeon has appropriate anatomical knowledge. In view of the low incidence of major anatomical variations, knowledge of standard inguinal nervous anatomy should be adequate. This procedure could enable the surgeon to prevent or recognize iatrogenic nerve damage and offer an opportunity to perform deliberate neurectomy as an alternative to accidental nerve injury.
开放腹股沟疝修补术中识别腹股沟神经与减少术后慢性疼痛相关。然而，大多数荷兰外科医生在进行该手术时并未识别出所有三条腹股沟神经。本研究的目的是评估识别神经的Lichtenstein疝修补术的可行性，并测量手术所需的额外时间。
来自荷兰四家不同教学医院的四位经验丰富的疝外科医生，对40例原发性腹股沟疝患者进行了识别神经的Lichtenstein疝修补术。记录识别每条神经所需的额外时间，并记录医源性神经损伤和解剖学特征。
髂腹下神经和髂腹股沟神经的识别均在1分钟内完成。股生殖神经生殖支的识别明显更困难，但通常可在2分钟内完成。与生殖支平行走行的提睾肌静脉的识别不太全面。主要解剖变异的发生率较低。然而，25%的髂腹股沟神经无法识别。在5例患者中，Lichtenstein疝修补术的标准操作过程中发生了医源性腹股沟神经损伤。
如果外科医生具备适当的解剖学知识，识别三条神经的Lichtenstein疝修补术是可行且不耗时的。鉴于主要解剖变异的发生率较低，标准腹股沟神经解剖学知识应足够。该手术可使外科医生预防或识别医源性神经损伤，并提供进行有意神经切除术以替代意外神经损伤的机会。
