PubMed · 7457754
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C P Karakousis. 1981. Ilioinguinal lymph node dissection.. https://doi.org/10.1016/0002-9610(81)90181-1
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With the development of the transabdominal preperitoneal secured prosthetic mesh repair, many laparoscopic surgeons feel not only that they have a procedure with a low recurrence rate, but that the procedure also has historic academic credibility. This repair emulates well-established open procedures. Shortcomings of this repair include a demand for more precise identification of structures, more careful dissection, and a higher risk of injury to important anatomical entities. There have been anecdotal reports of injuries to nerves such as the lateral femoral cutaneous nerve, the femoral nerve, and the genital branch of the genital-femoral nerve. This article reviews inguinal anatomy from the laparoscopic vantage point and identifies the areas where injury to nerves can occur.
Between 1962 and 1986, 208 inguinal and 143 ilio-inguinal lymphadenectomies were performed on 201 patients with carcinoma of the penis. The crude 5-year survival rate was 95% for patients with negative nodes, 76% when only inguinal nodes were positive, and 0% when the pelvic nodes were positive. The adverse prognostic factors were (1) involvement of > 3 inguinal nodes, (2) perinodal infiltration in the inguinal area, and (3) pelvic node involvement.
Before laparoscopic inguinal hernia repair can be widely adopted, general surgeons must become familiar with the laparoscopic presentation of the inguinal anatomy and must obtain practice with an effective technique that follows the surgical tenets of a good repair. This paper discusses some of the possible pitfalls of performing laparoscopic hernia repair and presents recommendations for success, including a brief description of a technique that has been used successfully in > 60 cases.