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Open Access 01-08-2020 | Ultrasound | Original Article

The inguinal region revisited: the surgical point of view

An anatomical–surgical mapping and sonographic approach regarding postoperative chronic groin pain following open hernia repair

Authors: M. Konschake, M. Zwierzina, B. Moriggl, R. Függer, F. Mayer, W. Brunner, T. Schmid, D. C. Chen, R. Fortelny

Published in: Hernia | Issue 4/2020

Abstract

Purpose

Inguinodynia or chronic post-herniorrhaphy pain, defined as pain lasting longer than 3 months after open inguinal hernia repair, has become the most important complication after inguinal surgery and therefore compromises the patient´s quality of life. A major reason for inguinodynia might be the lack of neuroanatomical knowledge and suboptimal “management” of the nerves during surgery.

Methods

We present a detailed neuroanatomic mapping of the inguinal region by dissection including the most important surgical landmarks with all nerves confirmed by immunohistochemistry, ultrasound guided visualization of the iliohypogastric, ilio-inguinal, and genital branch of the genitofemoral nerve, and a practical (preoperative) algorithm for clinical management.

Results

Surgically and ultrasonographically relevant structures (“landmarks”) in open hernia repair are the anterior–superior iliac spine, pubic tubercle, Camper´s fascia (superficial layer of the superficial abdominal fascia), External oblique aponeurosis, Internal oblique muscle, Transversus abdominis muscle, superficial inguinal ring, external spermatic fascia, cremasteric fascia with cremaster muscle fibers, internal spermatic fascia, cremasteric vein (=external spermatic vein = “blue line”), ductus deferens, pampiniform plexus, inguinal ligament and the inferior epigastric vessels.

Conclusion

A detailed understanding of inguinal anatomy is an indispensable basic requirement for all surgeons to perform inguinal ultrasonography as well as open inguinal hernia repair, avoiding complications, especially postoperative inguinodynia.

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Title: The inguinal region revisited: the surgical point of view
An anatomical–surgical mapping and sonographic approach regarding postoperative chronic groin pain following open hernia repair
Authors: M. Konschake
M. Zwierzina
B. Moriggl
R. Függer
F. Mayer
W. Brunner
T. Schmid
D. C. Chen
R. Fortelny
Publication date: 01-08-2020
Publisher: Springer Paris
Keywords: Ultrasound
Ultrasound
Inguinal Hernia
Published in: Hernia / Issue 4/2020
Print ISSN: 1265-4906
Electronic ISSN: 1248-9204
DOI: https://doi.org/10.1007/s10029-019-02070-z

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

The inguinal region revisited: the surgical point of view

An anatomical–surgical mapping and sonographic approach regarding postoperative chronic groin pain following open hernia repair

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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