Oliver J Muensterer1. 1. Department of Pediatric Surgery, University of Leipzig, Leipzig, Germany. oliver.muensterer@ccc.uab.edu
Abstract
PURPOSE: Genitofemoral nerve injury is an underappreciated complication after laparoscopic varicocele ligation in teenage boys. We describe the incidence according to ligation instrument and the pattern of spontaneous symptom resolution. MATERIALS AND METHODS: Patients who underwent laparoscopic varicocele ligation between 2004 and 2007 were retrospectively grouped by ligation modality (clipping or cautery by ultrasonic shears). The incidence of iatrogenic genitofemoral nerve injury was assessed and compared. To illustrate the pattern of resolution, 1 affected patient documented the decreasing area of paresthesia through time on a topographic map. RESULTS: During the study period laparoscopic varicocele ligation was performed using ultrasonic shears in 12 boys and endoscopic clips/cold dissection in 15. Genitofemoral nerve injury occurred in 2 patients using ultrasonic shears (17%) and no patient in the clip/cold dissection group (p = 0.10). In both patients the paresthesias resolved completely by 8 months. CONCLUSIONS: Genitofemoral nerve injury may be more frequent when the dissection is performed using "hot" methods such as cautery by ultrasonic shears. Preoperatively, patients should be made aware of the relatively high incidence and the usually self-limiting nature of this complication.
PURPOSE:Genitofemoral nerve injury is an underappreciated complication after laparoscopic varicocele ligation in teenage boys. We describe the incidence according to ligation instrument and the pattern of spontaneous symptom resolution. MATERIALS AND METHODS:Patients who underwent laparoscopic varicocele ligation between 2004 and 2007 were retrospectively grouped by ligation modality (clipping or cautery by ultrasonic shears). The incidence of iatrogenic genitofemoral nerve injury was assessed and compared. To illustrate the pattern of resolution, 1 affected patient documented the decreasing area of paresthesia through time on a topographic map. RESULTS: During the study period laparoscopic varicocele ligation was performed using ultrasonic shears in 12 boys and endoscopic clips/cold dissection in 15. Genitofemoral nerve injury occurred in 2 patients using ultrasonic shears (17%) and no patient in the clip/cold dissection group (p = 0.10). In both patients the paresthesias resolved completely by 8 months. CONCLUSIONS:Genitofemoral nerve injury may be more frequent when the dissection is performed using "hot" methods such as cautery by ultrasonic shears. Preoperatively, patients should be made aware of the relatively high incidence and the usually self-limiting nature of this complication.
Authors: Frank Friedersdorff; Seven Johannes Aghdassi; Peter Werthemann; Hannes Cash; Irena Goranova; Jonas Felix Busch; Jan Ebbing; Stefan Hinz; Kurt Miller; Joerg Neymeyer; Tom Florian Fuller Journal: Surg Endosc Date: 2013-04-03 Impact factor: 4.584