Complications - Shouldice Repair of Inguinal Hernia - general and visceral surgery
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Irritation, entrapment and injury of the inguinal nerves with persistent postoperative pain (ilioinguinal syndrome, genital nerve syndrome)
- The nerves were injured or divided during dissection. The particular nerves at danger are: lateral femoral cutaneous; ilioinguinal; iliohypogastric; genital; and femoral branches of the genitofemoral nerve. In iatrogenic division of these nerves they should be excised and infiltrated postoperatively with local anesthetics, since this will lower the risk of postoperative paresthesia. If the nerves are not divided but only irritated or touched, this may result in postoperative paresthesia which often is amenable to local anesthetics.
Injury to the spermatic duct
- How to proceed in any injury of the spermatic duct depends on the following aspects: Has the spermatic duct been divided completely or only partially? How old is the patient? Does the patient want to preserve his fertility?
- In elderly patients no longer sexually active the spermatic duct may be transected, otherwise this requires microsurgical suture. After the operation the patient must always be informed of what had happened and the consequences for him.
- In case of accidental iatrogenic bowel injury during the procedure the lesion should be immediately closed by suture.
Injury to the femoral artery and arterial hemorrhage
- Arterial hemorrhage from the femoral artery will result in rapid massive blood loss with the clinical sequela of hypovolemic shock. The bleeding must be noted and its source oversewn.
- If the bladder has been injured the lesion must be oversewn. Relieve the bladder for seven to ten days with a suprapubic catheter.