Ilioinguinal Research Articles

P102 FEMORAL NERVE PALSY POST OPEN INGUINAL HERNIA REPAIR - CASE REPORT AND LITERATURE REVIEW

Abstract Aim and Introduction “Inguinal hernia repair is one of the most common surgical procedures performed worldwide. Postoperative pain control is very important and recently nerve block has gained popularity as an alternative to opioid use. Transient femoral nerve palsy (TNFP) is a potential complication of ilioinguinal nerve block, but it is extremely rare with only a few cases reported. We discuss a case of TNFP post-left inguinal hernia repair to highlight this rare complication.” Material and Methods “Case Report: A 17-year-old male with clinically and radiologically confirmed left inguinal hernia underwent open mesh repair (Lichtenstein repair). At the end of the procedure, he had ilioinguinal and iliohypogastric nerve block (10ml, 0.5% bupivacaine). In the recovery room, he developed numbness of his anteromedial aspect of his left thigh with weakness of hip flexion and paralysis of quadriceps with an inability to extend his knee. He was reviewed by the anaesthetic team and was admitted overnight. His symptoms resolved spontaneously within 18 hours. He was subsequently discharged and followed up in the surgical OPD 2 weeks, 6 weeks and 6 months later and there were no residual neurological symptoms.” Results and Conclusion “TNFP post open hernia repair is very rare. Mechanisms of femoral nerve injury include suturing, stapling, scar tissue entrapment or direct compression. Careful attention is needed to the technique of local anaesthesia post-operatively (avoid deep infiltration, lowest volume and concentration used, ultrasound use) to avoid potential morbidity if this complication is not recognised.”

Novel loop neurorrhaphy technique to preserve lower lip sensate in mandibular reconstruction using an innervated vascularized iliac bone flap.

This study aimed to introduce a novel loop neurorrhaphy technique using an innervated vascularized iliac bone flap (VIBF) with vascularized ilioinguinal nerve (IIN) to reconstruct the inferior alveolar nerve (IAN) and preserve lower lip sensation simultaneously with mandibular reconstruction. This study prospectively included patients who underwent mandibular reconstruction using VIBF from May 2018 to April 2020. Subjects were allocated into two groups: (1) Group I; innervated VIBF with loop neurorrhaphy (IIN doubly anastomosed with IAN and mental nerve), (2) Group II (control); conventional VIBF. Evaluation was done with operative time, intraoperative indocyanine green (ICG), lower lip sensory assessment (two-point discrimination [TPD] test and current perception threshold [CPT]), and drooling. Twelve patients were included; 6 in each group, (7 males and 5 females), age ranging from 18 to 57 years (average: 36.75 years). In all cases, intraoperative perfusion of IIN was confirmed by ICG. Group I showed a statistically significant more flap harvesting time compared with group II (mean difference, 5.67 min; P= 0.0091). There was a significant difference in sensory recovery favoring group I (P< 0.05). The TPD results in group I showed an average of 9.8± 6.9 mm and 6.2± 5.7 mm on operated and non-operated sides, while Group II showed a poor sensory recovery, and the TPD showed an average of 24.6± 6.7 mm and 8.4± 2.3 mm on operated and non-operated sides. The CPT results showed a significant difference between both groups. In Group I, the extent of drooling was 3.16 ± 0.75, while in Group II, the score was 1.6± 0.81, revealing a significant difference favoring Group I. Concurrent mandibular reconstruction using VIBF and loop neurorrhaphy with vascularized IIN to reconstruct IAN successfully restore lower jaw form and preserve lip sensation.

Manual Therapy Treatment for Penile Pain- A Clinical Case Report with 6-Month Follow-up

ABSTRACT Background Male genital pain, which is neither related to genitourinary nor other obvious pathology, is an uncommon symptom in male patients and not frequently treated using manual therapy. The purpose of this case study is to describe a clinical reasoning process in combination with anatomy-based differential diagnosis and manual treatment for genital pain. Case Description A male patient with a 3-week acute onset of genital pain was hospitalized and referred for evaluation and treatment after unsuccessful treatment with medication and acupuncture. Clinical examination was performed indicating a possible nerve entrapment followed by interventions of ligamentous articular strain, high-velocity low-amplitude (HVLA) manipulation, and strain– and counterstain, coupled with soft tissue stretching to lumbar and inguinal areas to address a possible lumbar referral potentially from L1 and/or ilioinguinal nerve entrapment. Outcomes After 4 consecutive days of manipulative treatment, pain decreased from 9/10 to 0/10 and the Barthel Index improved from 50 to 95. A 6-month follow-up revealed complete resolution of symptoms with no recurrence. Discussion This case illustrates that a detailed history and examination along with a reasoned diagnostic process to determine an appropriate intervention strategy may improve patient care using manual therapy techniques. Conclusion: By utilizing a deductive reasoning process related to the penile area, clinicians may better apply manual therapy techniques for successful treatment.

US-guided Musculoskeletal Interventions of the Body Wall and Core with MRI and US Correlation.

Chest, abdominal, and groin pain are common patient complaints that can be due to a variety of causes. Once potentially life-threatening visceral causes of pain are excluded, the evaluation should include musculoskeletal sources of pain from the body wall and core muscles. Percutaneous musculoskeletal procedures play a key role in evaluating and managing pain, although most radiologists may be unfamiliar with applications for the body wall and core muscles. US is ideally suited to guide these less commonly performed procedures owing to its low cost, portability, lack of ionizing radiation, and real-time visualization of superficial soft-tissue anatomy. US provides the operator with added confidence that the needle will be placed at the intended location and will not penetrate visceral or vascular structures. The authors review both common and uncommon US-guided procedures targeting various portions of the chest wall, abdominal wall, and core muscles with the hope of familiarizing radiologists with these techniques. Procedures include anesthetic and corticosteroid injection as well as platelet-rich plasma injection to promote tendon healing. Specific anatomic structures discussed include the sternoclavicular joint, costochondral joint, interchondral joint, intercostal nerve, scapulothoracic bursa, anterior abdominal cutaneous nerve, ilioinguinal nerve, iliohypogastric nerve, genitofemoral nerve, pubic symphysis, common aponeurotic plate, and adductor tendon origin. Relevant US anatomy is depicted with MRI correlation, and steps to performing successful safe US-guided injections are discussed. Confidence in performing these procedures will allow radiologists to continue to play an important role in diagnosis and management of many musculoskeletal pathologic conditions. ©RSNA, 2021.

The genitofemoral and ilioinguinal nerves as neurorrhaphy candidates for erectile function restoration in patients with prostatectomy-induced erectile dysfunction

The genitofemoral and ilioinguinal nerves as neurorrhaphy candidates for erectile function restoration in patients with prostatectomy-induced erectile dysfunction

Elective Division Versus Preservation of The Ilioinguinal Nerve to Reduce Postoperative Pain in Hernioplasty for Inguinal Hernia

Elective Division Versus Preservation of The Ilioinguinal Nerve to Reduce Postoperative Pain in Hernioplasty for Inguinal Hernia

A pathological perspective to painful inguinal hernia: Report of two cases.

IntroductionPreoperative inguinal pain (painful inguinal hernia) is a well-known factor associated with chronic postoperative inguinal pain (CPIP). However, it remains unclear what preventive measures should be taken in such patients.Case presentationWe report two patients with painful inguinal hernia who underwent pragmatic ilioinguinal nerve neurectomy during open anterior repair. The nerve was compressed by bulky spermatic cord lipoma in case 1 and by the hernia sac presenting over a few decades in case 2. Hematoxylin and eosin staining of the resected nerves revealed mucoid degeneration. Toluidine blue staining of resin-embedded nerve sections demonstrated that fully-myelinated axons had significantly decreased in case 1 and almost disappeared in case 2, indicating the development of massive demyelination of the ilioinguinal nerve in both cases.DiscussionIn cases where the injured nerve is left in situ, CPIP may occur since demyelinating neuropathy sometimes becomes irreversible.ConclusionPlanned nerve resection via open anterior inguinal hernia repair may be an option to prevent CPIP in patients with painful inguinal hernia.

MP31-10 A COST EFFECTIVE OFFICE BASED TECHNIQUE FOR ULTRASOUND GUIDED PERI-SPERMATIC CORD CRYOABLATION FOR CHRONIC SCROTAL CONTENT PAIN

You have accessJournal of UrologyInfertility: Therapy (MP31)1 Sep 2021MP31-10 A COST EFFECTIVE OFFICE BASED TECHNIQUE FOR ULTRASOUND GUIDED PERI-SPERMATIC CORD CRYOABLATION FOR CHRONIC SCROTAL CONTENT PAIN Sijo Parekattil, Ahmet Gudeloglu, Onuralp Ergun, Alex Galante, Mohammed Etafy, and Richard Mendelson Sijo ParekattilSijo Parekattil More articles by this author , Ahmet GudelogluAhmet Gudeloglu More articles by this author , Onuralp ErgunOnuralp Ergun More articles by this author , Alex GalanteAlex Galante More articles by this author , Mohammed EtafyMohammed Etafy More articles by this author , and Richard MendelsonRichard Mendelson More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002035.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Prior publications have demonstrated the efficacy of ultrasound guided peri-spermatic cord cryoablation (PSC) as a salvage treatment for patients who failed microsurgical denervation of the spermatic cord (MDSC) for the treatment of chronic scrotal content pain (CSP). This previously published technique was performed in the hospital or ambulatory surgery center setting. Office based techniques offer the advantage of significantly reducing medical charges to the patient, since there are no facility fees. This study was designed to assesses an office based technique (OPSC) for PSC that may offer similar clinical outcomes at a significantly reduced cost to the patient. METHODS: A retrospective review of 35 OPSC cases (26 patients, 9 bilateral cases) between November 2020 to February 2021, performed by one fellowship trained microsurgeon. OPSC was performed under IV sedation in the office using a micro cryoablation needle (Cooper Surgical, Inc., Trumbull, CT). Branches of the genitofemoral, ilioinguinal and inferior hypogastric nerves were cryoablated medial and lateral to the spermatic cord at the level of the external inguinal ring. The level of pain was measured preoperatively and postoperatively using the Visual Analog Scale (VAS) and a validated Chronic Orchialgia Symptom Index (COSI). Median total surgical charges for the OPSC were analyzed for the office, ambulatory surgical center and hospital settings for comparison. RESULTS: Median patient age was 50. Median post-operative follow up was 1 month (1-3). 87% of the patients had a significant reduction in pain (19% complete resolution and 68% had a greater than 50% reduction in pain). No complications were reported. Table 1 below illustrated the median total surgical charges (including anesthesia charges) for the various clinical settings in our county region for PSC. The total surgical and anesthesia insurance charges for OPSC was significantly lower than in the ambulatory and hospital based settings (utilizing IV sedation in all these settings). CONCLUSIONS: Office based ultrasound guided peri-spermatic cord cryoablation (OPSC) is a safe, cost effective treatment option for the salvage management of persistent CSP in patients who have failed MDSC. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e558-e559 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sijo Parekattil More articles by this author Ahmet Gudeloglu More articles by this author Onuralp Ergun More articles by this author Alex Galante More articles by this author Mohammed Etafy More articles by this author Richard Mendelson More articles by this author Expand All Advertisement Loading ...

Effects of erector spinae plane block on postoperative pain in children undergoing surgery: A systematic review and meta‐analysis of randomized controlled trials

The erector spinae plane block is a novel regional anesthetic technique that is gaining popularity in pediatrics. However, the efficacy of erector spinae plane block in children is unclear. The aim of the systematic review and meta-analysis was to investigate effects of erector spinae plane block on postoperative pain relief in children. We searched MEDLINE, Cochrane Library, EMBASE, China National Knowledge Infrastructure, and Wan fang databases for randomized controlled trials that compared erector spinae plane block with no block or other types of block in pediatric patients undergoing surgeries. The primary outcomes were pain intensity at rest within 24h postoperatively and the number of patients requiring rescue analgesics. Data were analyzed using the fixed- or random-effects model, depending on whether the heterogeneity tested by the I2 statistic was >30%. We assessed the quality of evidence for the outcomes using the Grading of Recommendations, Assessment, Development, and Evaluation method. Seven randomized controlled trials involving 379 patients were reviewed. Compared with no block, erector spinae plane block slightly reduced the pain scores at 0h (standardized mean difference [SMD]: -1.07; 95% confidence interval [CI]: -1.60 to -0.54; I2 =52%), 6h (SMD: -0.82; 95% CI: -1.39 to -0.25; I2 =79%) postoperatively at rest and significantly reduced the need for rescue analgesics (odds ratio 0.09; 95% CI: 0.04 to 0.21; I2 =16%). One trial demonstrated the analgesic effect of erector spinae plane block was similar to a quadratus lumborum block, while another trial demonstrated the analgesic effect of ESPB was superior to an ilioinguinal nerve block. This review provides low-quality evidence that erector spinae plane block exhibits superior analgesia compared to no block in children. Due to the limited data, evidence regarding the comparison with other regional blocks remains unclear. Future large-sized and well-designed randomized controlled trials are needed.

Expiratory abdominal muscle nerve is active at flexor phase, while inspiratory phrenic nerve is not active during locomotion evoked by 5-HT and NMDA in the neonatal rat

Abdominal muscles are involved in respiration and locomotion. In the isolated pons-spinal cord-rib attached preparation from neonatal rat, the phrenic nerve and abdominal muscles show inspiratory and expiratory activity, respectively. Using this preparation, we investigated whether the bath application of NMDA and 5-HT could evoke locomotor activities in the fourth cervical ventral root (C4VR), phrenic nerve, and abdominal muscle nerve (ilioinguinal nerve, IIG-n). We also observed rib and abdominal muscle movements visually. The phrenic nerve and C4VR showed inspiratory activity consistently under the control conditions, whereas IIG-n showed expiratory activity only at the beginning of the experiment. During the chemically-induced locomotion, both C4VR and IIG-n showed locomotor activity, and IIG-n in particular showed flexor activity. During the flexor activity, lateral bending of the rib cage to the recording site was observed. The phrenic nerve showed weak or no apparent locomotor activity. We concluded that the central pattern generator (CPG) for locomotion provides stronger excitatory synaptic inputs to C4 motoneurons innervating neck and shoulder muscles than the inputs to the phrenic motoneurons. Thus, the locomotor CPG provides a suitable amount of inputs to the functionally proper motoneurons. This preparation will be useful to explore how the respiratory and locomotor CPGs select proper motoneurons to give synaptic inputs and are coordinated with each other.

DIVERSE ANATOMICAL CONFIGURATION OF ILIOINGUINAL NERVE IN RELATION TO LATERAL FEMORAL CUTANEOUS NERVE: A CASE REPORT

The variability in the formation of Ilioinguinal nerve has been documented in the literature especially related to iliohypogastric nerve. But so far very few cadaveric studies have been documented on variation in the branches of ilioinguinal nerve. A case presented which demonstrates aberrancy of its anatomic position. Although the course of ilioinguinal nerve has been well known, nostudies or report have demonstrated a course in relation to lateral femoral cutaneous nerve. This case report serves as a warning to the surgeon to be aware of such bizarre presentation since the consequences of iatrogenic injury to such structures may be serious.

Ultrasound-guided retrolaminar block versus ilioinguinal nerve block for postoperative analgesia in children undergoing inguinal herniotomy: A randomized controlled trial

Study objectiveUltrasound-guided retrolaminar block (RLB) is a new, safe and technically easy nerve block. To our knowledge, no studies have evaluated its analgesic efficacy in pediatric patients. This study aimed to compare the postoperative analgesic efficacy of RLB and ilioinguinal nerve block (INB) in pediatric patients undergoing unilateral inguinal herniotomy. DesignSuperiority, prospective, randomized, double-blinded, controlled study. SettingOperating rooms and wards of Mansoura University Children's Hospital, Egypt. PatientsSixty-five patients aged 2 to 6 years undergoing unilateral inguinal herniotomy were enrolled. InterventionsIn the ultrasound-guided RLB group (n = 30), we injected 0.5 mL/kg bupivacaine 0.25% into the retrolaminar space between the lamina of T12 and the paraspinal muscles and in ultrasound-guided INB group (n = 30), 0.5 mL/kg bupivacaine 0.25% was injected for INB. MeasurementsThe primary outcome measure was the number of patients requiring ibuprofen as rescue analgesia and the secondary outcome measures were intraoperative hemodynamic changes and the postoperative FLACC (Face, Legs, Activity, Cry, Consolability) score. Main resultsThe number of patients who needed rescue analgesia in the first postoperative 24 h was significantly lower (P = 0.023) in the RLB group [5 (16%)] than the INB group [13 (43%)]. The mean (SD) arterial blood pressure and heart rate were significantly higher (P < 0.001) during sac traction in the INB group [74.07 (2.99), 97.33 (6.98)] than the RLB group [67.73 (3.55), 90.79 (5.13)]. The postoperative FLACC scores at 4, 6, 12, and 24 h were significantly lower (P < 0.05) in the RLB group than in the INB group. ConclusionRetrolaminar block is superior to ilioinguinal nerve block in providing postoperative analgesia in pediatric patients undergoing unilateral inguinal herniotomy.

A COMPARISON STUDY BETWEEN ULTRASOUND-GUIDED AND CONVENTIONAL (BLIND) ILIOINGUINAL/ ILIOHYPOGASTRIC NERVE AND GENITAL BRANCH OF GENITOFEMORAL NERVE BLOCKS FOR OPEN INGUINAL HERNIA REPAIR.

Background: Inguinal hernia repair is the commonest operation in surgical practice. Now it is also performed under regional nerve blocks by blocking nerves ilioinguinal (II)/iliohypogastric (IH) and genital branch of genital femoral nerve combined with a surgical feild inltration with a long-acting local anaesthetic(LA) agent. LA inltration improves acute postoperative pain management, decreases postoperative visual analogue scale(VAS)scores, opioid demand, and time to rst rescue analgesic administration. Thi Objective: s study was carried out to compare the effect of ultrasound guided ilioinguinal/ iliohypogastric nerve and genital branch of genitofemoral nerve block with conventional (blind) block in terms of success rate, postoperative analgesia and complications. Method: We conducted a prospective randomized controlled studyamongst 100 ASA I-III patients posted electively for open inguinal hernia repair. Various parameters such as age, sex, weight, BMI, vitals like pulse rate, ECG, blood pressure was recorded and Post-Operative VAS at 30minutes, 1hr, 1hr30mins, 2hrs, 2hrs30mins, 3hrs, 3hrs30 minutes and 4hours was noted. Qualitative and quantitative analysis was done. Result: In conventional group 8 (16%) patients amongst 50 (100%) required general anaesthesia in between the surgery even after sedation + analgesia+ propofol whereas in USG group 2 (8%) patients required general anaesthesia. The patient receiving USG guided block had signicantly lower post-operative VAS scores till 2 hours 30 mins as compared to the patient receiving conventional ILN/INH nerve blocks who had higher VAS scores . There Conclusion : by we found that ultrasound guided block for open inguinal hernia repair has signicantly better patient care in comparison with conventional block.

The Efficacy and Safety of Local Anesthetic Techniques for Postoperative Analgesia After Cesarean Section: A Bayesian Network Meta-Analysis of Randomized Controlled Trials.

ObjectiveCesarean section (CS) is one of the most frequently performed major surgical interventions. Local anesthetic techniques, a universal component of perioperative multimodal analgesia, are reportedly effective in reducing pain scores and opioid requirements. However, the optimal local anesthetic technique for postoperative CS pain remains unclear.MethodsSix databases were searched, and a Bayesian network meta-analysis was performed. The outcomes included cumulative morphine consumption and pain scores at four time points, time to first analgesic request, postoperative nausea and vomiting, pruritus, and sedation.ResultsSixty-eight studies with 5039 pregnant women were included. Six local anesthetic techniques were involved, including transversus abdominis plane block (TAPB), ilioinguinal and iliohypogastric nerve block, quadratus lumborum blocks, transversalis fascia plane block, erector spinae block, and wound infiltration. Compared to inactive controls, TAPB reduced cumulative morphine consumption at 6, 12, 24, and 48 h, pain scores at 6, 12, and 24 h (with the exception of 24 h at rest), the risk of postoperative nausea and vomiting, and sedation. Compared with inactive controls, ilioinguinal and iliohypogastric nerve block reduced cumulative morphine consumption at 6 and 24 h and pain scores at 6, 12, and 24 h during movement. Compared with inactive controls, quadratus lumborum blocks reduced cumulative morphine consumption at 24 and 48 h and pain scores at 6 and 12 h and lengthened the time to first analgesic request. Compared with inactive controls, wound infiltration reduced cumulative morphine consumption at 12 and 24 h, pain scores at 12 and 24 h during movement, and risk of sedation. Compared with inactive controls, erector spinae block reduced pain scores at 6 and 12 h. Transversalis fascia plane block was found to have similar outcomes to inactive controls.ConclusionTAPB is the most comprehensive local anesthetic technique for postoperative CS analgesia in the absence of intrathecal morphine.

Impacto do Músculo Iliopsoas: Uma Nova Etiologia para Dor Neuropática Ilioinguinal / Iliohipogástrica?

Groin pain is a frequent athletic injury with a multitude of etiologies, being ilioinguinal and iliohypogastric nerve pain one of the most frequent causes. We present a case of a trail running athlete with a groin pain in the ilioinguinal and iliohypogastric nerve territory that was refractory to conventional treatment. Three months after the initial symptoms, he was submitted to incobotulinum toxin injection in the iliopsoas muscle fibers that were adjacent to the nerves, in the inguinal area. The symptoms quickly disappeared, pointing the iliopsoas muscle as a possible cause of ilioinguinal and iliohypogastric nerve impingement and providing new insights into this pathology.

Gold Standard Care of Chronic Scrotal Pain.

IntroductionChronic scrotal pain (CSP) can be a debilitating condition for patients and is often difficult to characterize.MethodsA review of literature was performed using Embase, Cochrane and Medline databases in the period 1.January 2010 to 1.January 2021. We found 132 articles, and the authors screened abstract and references. Thirty-seven articles are included after removing duplicates.ResultsThis review presents a variety of medical and surgical treatment options for CSP such as spermatic cord blocks (36–80% success rate), microsurgical denervation of the spermatic cord (76–100% success rates), Botox (56% success rate), targeted ilioinguinal and iliohypogastric peripheral nerve stimulation, and radical orchiectomy (55–75% success rate).ConclusionAn overview of various treatment options, both non-surgical and surgical are provided, with the aim of establishing what may be the best treatment option for CSP.

Spinal Level Contribution of Nerves of the Lumbar Plexus ‐ A Systemic Review and Meta‐Analysis

Introduction The human lumbar plexus emanates from the lumbar spine providing sensory and motor innervation to the abdominal wall, suprapubic region, external genitalia, inguinal region, and the thigh.The lumbar plexus or its branches may be injured during open and laparoscopic herniorrhaphy, lateral approaches to spinal fusion surgery, iliac crest bone graft harvesting, and other procedures. Health care providers especially surgeons should be aware of these variations to avoid injuries to the nerves. The natural anatomical variation between individuals greatly contributes to the uncertainty surrounding procedural outcomes. Many publications describing the human lumbar plexus have been reported in the literature; however, these reports are frequently contradictory, owed potentially to the natural variation in the genetic composition of human populations and small sample sizes. The aim of performing a systematic review and meta-analysis of the published literature regarding lumbar plexus morphology is an appropriate step forward in ascertaining a more accurate view of the nerves. Materials and Methods A systematic review and meta-analysis using PRISMA guidelines were designed to access the literature published about the spinal levels of origin contributing to the nerves of the lumbar plexus. A comprehensive search was carried out through PubMed, Google Scholar, and CINAHL with specific search terms. Two independent reviewers evaluated the Title and Abstract of qualifying articles discovered from index searches. Data from qualifying publications were extracted and aggregated. Results We evaluated 1522 studies from the online databases and excluded any publications after January 31, 2020. Thirteen studies of the femoral nerve (773 total nerves) were found to originate from the spinal nerves as follows: L2-L4 82.8%, L1-L4 6.2%, L3-L4 4.4%, L3-L5 2.2%, L1-L3 1.4%, L4 0.6%, L5 0.4%, L2-L5 0.3%, T12-L4 0.3%, L2-L3 0.3%, T12-L3 0.3%, L3 0.1%, and missing or unreported 0.8%. Ten studies of the obturator nerve (477 total nerves) were as follows: L2-L4 82.8%, L4 8.4%, L1-L4 3.4%, L1-L3 1.5%, L3-L4 1.5%, L2-L3 0.8%, L3 0.4%, L5 0.4%, T12-L3 0.4%, L2-L5 0.2%, and L3-L5 0.2%. Ten studies of the ilioinguinal nerve (629 total nerves) were found as follows: L1 80.8%, L1-L2 6.2%, T12-L1 6%, L2-L3 3.5%, L2 0.6%, T12 0.5%, L3, 0.2%, and missing or unreported 2.2%. Nine studies of the iliohypogastric (429 total nerves) were found as follows: L1 83.2%, T12-L1 12.4%, T12 2.6%, and missing or unreported 1.9%. Twelve studies of the lateral femoral cutaneous nerve (580 total nerves) were found as follows: L2-L3 71.6%, L2 10.2%, L1-L2 4.8%, L2-L4 2.9%, L1-L3 1%, L3 1%, L1 0.7%, T12-L1 0.2%, and missing or unreported 7.6%. Nine studies of the genitofemoral nerve (457 total nerves) were as follows: L1-L2 81.4%, L2 9%, L1 2.6%, L2-L3 1.5%, L1-L3 1.1%, T12-L1 0.9%, and missing or unreported 3.5% of cases. Conclusion The result of this study showed the vast number of variations of the different nerves of the lumbar plexus from its spinal levels. Lesions to the lumbar plexus are rare and difficult to treat. The lumbar plexus may be injured during clinical interventions; thus, the knowledge of these variations is important to physicians, surgeons, and anesthesiologists.

Innervation of the scrotum by the anterior division of the obturator nerve – a rare variation

The scrotum is supplied by ilioinguinal, genital branch of genitofemoral, perineal branch of the posterior cutaneous nerve of the thigh and the posterior scrotal branches of the pudendal nerve. We report an extremely rare innervation of the anterior part of the scrotum by the anterior division of the right obturator nerve. The genital branch of genitofemoral nerve did not reach the scrotum. The ilioinguinal nerve did not supply the scrotum. The anterior division of the obturator nerve gave a branch which ascended superomedially in the thigh, crossed superficial to the spermatic cord and communicated with the right ilioinguinal nerve. As it crossed the spermatic cord, it gave a scrotal branch which descended over the spermatic cord and ramified to supply the anterior part of the scrotum. Knowledge of this variation could be important to anaesthesiologists, urologists and surgeons in general.

A Clinical Study on Left Sided Indirect Inguinal Hernia Containing Sigmoid Colon

Aim: The aim of this article is “A clinical study on left-sided indirect inguinal hernia containing sigmoid colon”. In this study, we have projected the incidence and management of sliding inguinal hernia containing a Sigmoid colon. Materials and Methods: A three years retrospective clinical study, was done at the “General Surgery department” at Vydehi Institute of Medical Science and Research Centre, White field Bengaluru-560 066. This Institute is a tertiary hospital attached to a medical college. Results: This analysis contained a total of 189 cases. Sliding sigmoid colon occurrence is very rare and only one case, which is less than one percent, was found in this study (0.52 percent). Conclusion: The sigmoid sliding hernia is a peroperative diagnosis among left-sided indirect inguinal hernia. The surgical management/repair is meticulous and needs gentle dissection after identification of the sigmoid colon. Care must be taken to identify the contents of the hernia to avoid inadvertent injury to the structures. The Lichtenstein repair could be considered to lower recurrence and reoperation rates. Surgeons should function according to these standards and it is of utmost significance to be accompanied by a wide variety of prosthetic materials. Key words: Sliding hernia; Amyand’s hernia; Littre’s hernia; Meckel’s diverticulum; Spermatic cord; Round ligament of uterus; Inguinal (Poupart) ligament; Ilioinguinal nerve; Genital branch of the genito-femoral nerve; Midpoint of the inguinal ligament; EOM External oblique muscle IOM Internal oblique muscle PT-Pubic Tubercle; PS Pubic Symphysis; Hesselbach’s triangle; ASIS=Anterior superior iliac spine.

A clinical study: Inguinal hernia repair under local block

This study was conducted to evaluate advantages of local anaesthesia in high risk patients and to assess patient’s satisfaction, speed of recovery and postoperative analgesia. In our study we gave combined Ilioinguinal and Iliohypogastric nerve block with field block in 30 patients. The patients were monitored for hemodynamic changes and total duration of analgesia and quality of analgesia. In this study 23% patients were of ASA I, 30% ASA II and 46.7% had ASA III grade. All patients were hemodynamically stable throughout procedure and surgery. Average duration of the analgesia was 188 min (about 3 hours). Quality of analgesia was excellent in 66.6% patients, good in 16.6% patients, poor in 6.6% patients and 10%patients had severe intolerable pain and converted to GA. We found that inguinal hernia repair under local anaesthesia was safe, simple, cost-effective and also provides good postoperative analgesia. It is more useful in high risk patients where we need to avoid effects of general, spinal or epidural anaesthesia for hernia surgeries.