Femoral Neuropathy After Vaginal Hysterectomy: Two Case Reports and Review of the Literature

Abstract

Femoral neuropathy is a known complication of abdominal hysterectomy but occurs uncommonly after vaginal hysterectomy. Two cases of this complication after vaginal hysterectomy are described, with discussion of possible etiology, treatment, and preventive measures. Both patients had large thighs and were positioned with hyperflexion of the hips. Both procedures were prolonged. Unilateral and bilateral femoral neuropathies were noted postoperatively. Treatment involved physical therapy, nonsteroidal anti-inflammatory medication, and mechanical support. Spontaneous recovery occurred in 29 and 40 days. Femoral neuropathy can occur after prolonged vaginal hysterectomy secondary to compression of the nerve at the level of the inguinal ligament. Obese women appear to be more at risk. Prevention involves avoiding extremes of flexion, external rotation, and abduction of the hips when positioning the patient and avoiding leaning on the patient's thighs. Treatment is supportive, with full recovery anticipated. (J GYNECOL SURG 13:191, 1997)