Review of retroperitoneal neuroanatomy in transabdominal preperitoneal approach for inguinal hernia repair Masato NARITA 1 , Kyosuke MIYAZAKI 2 1Department of Surgery, Kyoto Medical Center 2Miyazaki Surgery & Hernia Clinic Keyword: 鼠径ヘルニア術後慢性疼痛 , TAPP , 合併症 pp.473-483
Published Date 2019/11/15
DOI https://doi.org/10.11477/mf.4426200748
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 Recently, increasing number of patients undergo transabdominal preperitoneal approach (TAPP) for inguinal hernia repair in Japan. Although TAPP is reported to have advantages in early postoperative pain compared to anterior repair with mesh, it has been also reported that severe postoperative neuropathic pain sometimes occurs in patients undergoing TAPP. Therefore, awareness and recognition of retroperitoneal neuroanatomy is mandatory to perform TAPP safely. Japanese guidelines for treatment of inguinal hernia describe management of ilioinguinal, iliohypogastric, genital branch of genitofemoral nerves in patients undergoing anterior repair to prevent postoperative chronic pain, while there is no description of nerve management during TAPP. This review article summaries the anatomy of additional three nerves including femoral branch of genitofemoral, femoral, and lateral femoral cutaneous nerves, which are vulnerable to injury during TAPP and discusses pitfalls in this procedure. The aim of this review is to increase the surgeon's awareness and knowledge, particularly for young surgeons, about retroperitoneal neuroanatomy in order to perform TAPP safely.

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