V9-07: Microsurgically-Assisted Inguinal Hernia Repair
: Inguinal hernia repair is the most commonly performed general surgical procedure, with mesh repair being the favored method. Complications such as chronic pelvic pain and iatrogenic vasal obstruction can occur in up to 19% and 3% of patients, respectively. Better intraoperative visualization of the ilioinguinal nerve has been associated with decreased postoperative pelvic pain. The operating microscope offers the best visualization of inguinal structures and is commonly used in highly precise male infertility procedures. We describe the rationale, technique, and surgical outcomes of microsurgically assisted inguinal hernia repair.
We conducted a retrospective review of 252 microsurgically assisted hernia repairs with mesh performed by a single surgeon (M.G.). In all procedures, the vas deferens, deferential vessels and nerves, ilioinguinal nerve, genital branch of the genitofemoral nerve, and spermatic vasculature were identified and preserved under 6-25X magnification. Surgical outcomes and complications were abstracted retrospectively from patient charts.
Mean follow-up was 26.7 months. Mean patient age was 50.5 years. 196/252 (78%) of patients were symptomatic from their hernias. 215/252 (86%) of patients were undergoing concomitant microsurgical fertility related procedures such as varicocelectomy (56%) and hydrocelectomy (28%). No chronic post-operative pain or vasal injuries were reported. Additionally, no sensory loss or infections were reported. The only complications were one post-operative one hematoma (0.4%) that was managed conservatively and one recurrence (0.4%).
Operating microscopes have an established record of facilitating extremely difficult male infertility procedures. The application of the operating microscope for inguinal hernia repair resulted in very low complication rates under 1%. Remarkably, there were no instances of chronic post-operative pain or sensory loss, representing significantly improved surgical outcomes compared to those reported in the literature.
Funding: Frederick J and Theresa Dow Wallace Fund of the New York Community Trust & the Agency for Healthcare Research and Quality (T32HS00066)_x000D_ _x000D_ This work was supported in part by the Urology Care Foundation Research Scholar Award Program and AUA New York Section Research Scholar Fund