Inguinal Herniorraphy Research Articles

P-058 IMMEDIATE USE OF PERITONEAL DIALYSIS AFTER SIMULTANEOUS LAPAROSCOPIC PLACEMENT OF PERITONEAL DIALYSIS CATHETER AND INGUINAL HERNIA REPAIR

Abstract Background Peritoneal dialysis is accepted renal placement therapy for end-stage renal disease (ESRD). Managing inguinal hernia in peritoneal dialysis (PD) patient is not standardized. Moreover, the occurrence of occult hernia post PD placement needs surgical planning. This work aims to report the outcome of simultaneous laparoscopic placement od PD catheter and transabdominal preperitoneal (TAPP) repair of inguinal hernia. Methods All patients underwent laparoscopic PD catheter placement for ESRD from September 2016 to July 2021 were reviewed. Patients who underwent Concurrent Laparoscopic Inguinal Herniorraphy and Laparoscopic PD catheter placement were involved. PD with inflow measurement of the amount and should be below the incised peritoneum by 1 inch and smooth inflow and outflow without leakage. The amount raised gradually in two weeks to reach the targeted PD. Results Laparoscopic PD catheter placement was inserted for 13 patients with inguinal hernia. Two patients had bilateral inguinal hernia, one patient with umbilical hernia, and one patient diagnosed with hernia intraoperatively. The safe amount of dialysate fluid was from 400 to 600ml. There was no mortality, intraoperative complications or fluid dialysis leak. One patient had catheter displacement which was repositioned laparoscopically. Three catheters were removed due to non-compliance. No hernia recurrence observed. Conclusion Simultaneous laparoscopic PD catheter placement and TAPP repair herniorrhaphy with immediate use of PD is safe and effective. Our surgical approach allows using minimal invasive technique in the management of both PD catheter placement and inguinal hernia repair without delaying PD.

Pulsed electromagnetic field therapy versus extracorporeal shock wave therapy in the treatment of iliohypogastric neuralgia postinguinal herniorrhaphy

To evaluate the efficacy of pulsed electromagnetic field therapy versus extracorporeal shock wave therapy in the treatment of iliohypogastric neuralgia post inguinal herniorraphy.Measurement of the serum cortisol level and the carbamazepin medicament intake. 40 male and female patients with iliohypogastric neuralgia post inguinal herniorraphy were divided into two groups. Group (A) received the thoracolumbar pulsed electromagnetic field therapy.Group (B) received the thoracolumbar extracorporeal shock wave therapy, duration of treatment was 20 minutes, every other day for the 3 months as a total period of treatment in addition to the traditional physical therapy and medical care for 3 months in group (A) and in group (B) the following parameters were used as following: 1,000 impulses; energy flux density (ED) varied from the lowest (0.08 mJ/mm2) to the highest energy level (0.44 mJ/mm2), depending on patient’s pain tolerance, on the trigger point area,over the thoracolumbar region paravertebrally once every two weeks for 12 weeks (3 months) on the affected side, the handpiece of the ESWT device was positioned perpendicular on the target area of treatment and moved circular over gel that was used over the target area of treatment in addition to the traditional physical therapy and medical care for 3 months.

Laparoscopic inguinal hernia repair: Clinical features

Background: Since the early 1990s, laparoscopic techniques have share the scene on general surgery; the initial operations with laparoscopic inguinal herniorraphy were reported in 1992. Trans-abdominal preperitoneal (TAPP) inguinal herniorraphy starts with detailed laparoscopic exploration of both inguinal region and intraperitoneal area. Afterwards a second incision perform to the peritoneal layer to minimise the extent of hernia sac and maintain a shield for prosthetic mesh to lay on the other side of inguinal wall on preperitoneal space. The aim of this study was to demonstrate the rates of recurrence and postoperative complications of TAPP procedure.Methods: In this retrospective study 21 cases of inguinal hernia that underwent TAPP procedure included. All cases operated by the same surgical team and with the same surgical technique.Results: Within 4 weeks, 71.4% of the patients reportedly had completely recovered from surgery. By 8weeks, 100% reportedly had complete resolution of postoperative symptoms. No serious intraoperative complications occurred. No cases required conversion to open surgery. In 1 patient (%4.7) urinary retention has occured as the only early postoperative complication. Two patients (%9.5) described numbness without pain in the distribution of the lateral femoral cutaneous nerve. One patient (%4.7) had mild testicular tenderness. None of these patients required pain medication or other interventions. On the follow-up time no recurrence has occured.Conclusion: In this study we demonstrate the very low rates of TAPP in respect of intra/postoperative complication–especially low rates of inguinal pain-, recurrence and improved time to return daily activities.

Results of using the method of full extraperitoneal endoscopically assisted ligation of the hernial sac with inguinal hernia in children

Background/PurposeThe aim of this study was to evaluate the effectiveness of a new technique for inguinal hernia repair in children: pediatric hernia extra-peritoneal ligation and percutaneous suturing (PHELPS) in comparison with another laparoscopic technique, subcutaneous endoscopically assisted ligation (SEAL). MethodsWe demonstrate the results of laparoscopic treatment of 680 patients with inguinal hernias. Of these, 206 patients were operated using the new PHELPS technique. The remaining 474 children received the SEAL technique. The difference between the methods is that PHELPS consists of ligating the hernia around the neck of the hernial sac, including an intra-peritoneal component (aponeurosis and muscles), while the SEAL technique ligates the hernia sac only. We examined whether this factor may lead to more recurrence and hydrocele in the SEAL technique. ResultsBoth groups of patients were comparable in terms of age, body weight at the time of surgery, and gender. The average total duration of inguinal herniorraphy, including the time of surgery in patients with one-and two-sided hernia localization, was comparable in both groups (17.50 min versus 17.22 min; p = 0.518). The study demonstrated a faster recovery of patients after using the PHELPS technique for the treatment of inguinal hernias, consisting in a statistically significantly lower number of doses of postoperative analgesia (1.01 versus 1.31; p < 0.001) and a shorter time of patient stay in the hospital (8.06 h versus 8.78 h; p = 0.031). Despite the fact that there were no statistically significant differences in the frequency of postoperative hydrocele (0 versus 6; p = 0.090), we found a statistically significant difference between the groups in terms of recurrence (0 versus 17; p < 0.001). ConclusionsThe PHELPS technique shows improved results in terms of recurrence and hydrocele as compared to SEAL. Level of EvidenceLevel III Type of studyRetrospective Comparative Study

A Case of Leukemia Cutis in an Inguinal Herniorraphy Scar

Leukemia cutis refers to the infiltration of the skin with leukemia cells. It is a rare extramedullary manifestation of leukemia, but it is a specific sign of disease progression and bad prognosis. Cases of leukemia cutis in sites of skin trauma or surgical scars have been described, but there are very few cases reported in literature. We report a case of a 65-year-old male previously diagnosed with chronic myelomonocytic leukemia that was showing clinical signs of progression to acute myeloid leukemia. He underwent right inguinal herniorrhaphy three months before and was showing poor wound healing. Surgical site infection was suspected, since blood tests showed prolonged neutropenia, so surgical wound debridement was performed. Pathological findings of removed tissue indicated infiltration by leukemic cells, which led to the diagnosis of leukemia cutis, not suspected until that moment. Therefore, we conclude that an exhaustive skin examination (especially in the presence of skin trauma or surgical scars), should be performed in patients with confirmed or suspected diagnosis of leukemia. Moreover, the possible diagnosis of leukemia cutis should be considered in leukemia patients who present cutaneous infectious complications or suboptimal healing following accidental skin trauma or surgery. In these cases, complementary anatomopathological studies should be performed.

A Comparative Study Between Magnesium Sulfate Versus Morphine Added to Bupivacaine in Ultra-Sound Guided Transversus Abdominis Plane Block for Post-Operative Analgesia after Inguinal Herniorraphy

Abstract Background Inguinal hernia considered the third common disease in surgeries for adult after acute appendicitis and proctologic disorders. About 20 millions of inguinal hernia repairs are performed globally. Inguinal herniorrhaphy is frequently associated with persistent postoperative pain. A significant proportion of pain experienced by patients undergoing abdominal surgeries is related to somatic pain signals derived from the abdominal wall. Aim of the Work The aim of this study is to assess the postoperative analgesic efficacy of Magnesium sulfate added to Bupivacine verus Morphine to Bupivacaine in ultrasound guided transversus abdominis plane (TAP) block after inguinal herniorraphy regarding the pain relief and the amount of rescue analgesia used postoperative. Patients and Methods The study was conducted on 45 randomly chosen patients in Ain Shams University Hospitals after approval of the medical ethical committee. They were allocated in three groups of 15 patients each: Group - I (B): received TAP block with Bupivacaine only as a “Control Group”. Group - II (B-MO): received TAP Block with Bupivacaine plus Morphine. Group - III (B-Mg): received TAP block with Bupivacaine plus Magnesium Sulfate. The three groups were adequately monitored and assessed intra- and post-operatively and they were compared regarding analgesic outcome by using the visual analogue scaling system, besides, recording time for first call for rescue analgesia and total consumption of it in the 1st 24 postoperative hours. Demographic data and post-operative hemodynamics were also assessed. Results The results of the study revealed that Magnesium added to bupivacaine better than Morphine added to Bupivacaine in transversus abdominis plane block regarding the postoperative analgesia after inguinal Herniorraphy. Conclusion In Conclusion the addition of MgSo4 as an adjuvant to bupivacaine in TAP block has shown superiority over either mono-therapy with bupivacaine or bupivacaine-Morphine combination in many aspects such as postoperative analgesic outcome assessed by VAS score, 1st time of rescue analgesia and without the pronounced side effects of the conventional postoperative opioids and less side effect than Morphine.

Ultrasound-guided nerve block for pediatric inguinal herniorrhaphy

ABSTRACT Background and aim Regional anesthesia is one of the best options anesthetic technique, it was very difficult to be used in pediatrics anesthesia, now a days it becomes more easier and safer with the era of high-quality ultrasound. This study aimed to assess the effectiveness of ultrasound-guided nerve block (ilioinguinal/iliohypogastric; II/IH) in pediatric unilateral inguinal herniorraphy, time for first analgesic dose, parents, surgeon satisfaction and complication. Patients and methods The study was done in Zagazig university hospital after approval of the ethical committee. Induction of anesthesia using sevoflorane MAC (Minimal Alveolar Concentration) 4%-6% then Laryngeal Mask Airway was inserted (LMA). Ultrasound-guided (ilioinguinal/iliohypogastric) nerve block was performed on 20 male pediatric patients their age ranged from 4 to 10 years old with ASA status I and II, with unilateral inguinal hernia.hemodynamics as heart rate (HR) blood pressure systolic/diastolic (SBP/DBP) was reported also Children Infants Postoperative Pain (CHIPPS) score was recorded every 2 h until 12 h and time for first analgesic dose also reported. Results Our result showed no significant changes in heart rate (HR) and blood pressure (BP) at skin incision; HR (95 ± 8), BP (97.6±/50 ± 5) and intraoperative HR (93.5 ± 6), BP (99.6 ± 9/51 ± 4) compared with the basal readings; HR (113 ± 10), BP (104 ± 12/53 ± 6). Pain score was evaluated using (ChIPPS), it started to increase after 4 to 5 h and reported by first analgesic dose (5.2 ± 1.5) that managed by paracetamol (15 mg/kg/day). Surgeon and parents were satisfied. Early ambulation and less hospital stay. Less complications (no motor block or urine retention). Conclusion Ultrasound-guided (ilioinguinal and iliohypogastric) nerve block was found to be an ideal intraoperative anesthetic and postoperative analgesic for unilateral inguinal herniorrhaphy in children with no complications.

Femoral nerve injury following laparoscopic hernioplasty for inguinal hernia: open exploration of the groin and neurolysis after two months

Purpose: Complications after inguinal hernia repairs, laparoscopic or open are uncommon but well known to surgeons. Since the introduction of laparoscopic herniorraphy several cases of nerve injuries were reported but few of them concerning the femoral nerve. Case report: The case of a 36 year old female patient is discussed, who suffered from severe pain in the right thigh and the right knee after laparoscopic hernioplasty for a unilateral right inguinal hernia. The surgeons who operated the patients suggested that the symptoms were due to a meniscus lesion and an earlier prolapsed O4-O5 intervertebral disc. The patient referred to our hospital two months later, where she underwent meticulous clinical and laboratory examination. Femoral nerve injury was diagnosed and surgical exploration was performed where the femoral nerve was found stapled and the staple was “unscrewed” from it. Symptoms radically and rapidly improved after the operation. Conclusion: Good anatomic knowledge and experience is important during laparoscopic inguinal hernia repairs so as to avoid the “danger zone” and thus injuring the nerves of the groin while stapling the mesh. Diagnosis and treatment of nerve injury following laparoscopic inguinal herniorraphy is a difficult and controversial task for the surgeon. We recommend a meticulous clinical and laboratory investigation; these patients should undergo early surgical treatment when and if needed. Keywords: inguinal hernia, laparoscopic inguinal hernia repair, femoral nerve injury, groin nerve injury

Evaluation of Natural Tissue Reinforcement of Inguinal canal For Inguinal Hernia Repair (Desarda Inguinal Herniorraphy)

Background: Inguinal hernia repair is one of the cornerstones of a general surgery practice and is one of the most commonly performed procedures. Although there are no exact figures totaling the number of inguinal hernia repairs performed annually, it has been estimated that approximately 800,000 cases were performed annually in 2003, not including recurrent or bilateral hernias. Aim: To report our experience in recording and evaluating the short-term outcome of inguinal hernia repairs with Desarda's technique. Patients and Methods: A total of 20 adult male patients with primary inguinal hernias were randomly allocated intraoperatively to undergo Desarda inguinal herniorraphy. Results: According to our scale evaluating outcome, desarda technique is effective and safe with least post-operative complications regarding inguinal hernia repair. Conclusion: Desarda repair is easy to perform and has shown to take shorter operative time. Also, there is no need of mesh with less suture material requirement. So, this method proves cost effective than the Lichtenstein method. Desarda hernia repair was found to be superior to Lichtenstein repair in terms of post-operative pain and foreign body sensation. It can be recommended for younger patients.

Evaluation of Natural Tissue Reinforcement of Inguinal canal For Inguinal Hernia Repair (Desarda Inguinal Herniorraphy)

Evaluation of Natural Tissue Reinforcement of Inguinal canal For Inguinal Hernia Repair (Desarda Inguinal Herniorraphy)

Is spinal anaesthesia in young infants really safer and better than general anaesthesia?

Concerns regarding the potential neurotoxic effects of general anaesthesia have seen resurgence in awake spinal anaesthesia in neonates and infants. This review includes recently published data from a large prospective randomized controlled trial with view to determining if spinal anaesthesia is safer and better than general anaesthesia in this population. Compared with general anaesthesia, spinal anaesthesia results in less haemodynamic instability and fewer early (<30 min) apnoeic episodes in neonates and infants undergoing inguinal herniorraphy; the overall incidence of apnoeas in the first 12 h postoperatively was similar. Neurodevelopmental outcome 2 years postoperatively was similar. An appreciable failure rate for spinal anaesthesia was confirmed. Spinal anaesthesia represents a suitable alternative to general anaesthesia in neonates and infants undergoing minor surgery avoiding the need for endotracheal intubation and ventilation. Spinal anaesthesia has some advantages but a significant failure rat and has not been demonstrated to improve neurodevelopmental outcome.

The GroinPain Trial: A Randomized Controlled Trial of Injection Therapy Versus Neurectomy for Postherniorraphy Inguinal Neuralgia.

This study compares tender point infiltration (TPI) and a tailored neurectomy as the preferred treatment for chronic inguinodynia after inguinal herniorraphy. Some 11% of patients develop chronic discomfort after open inguinal herniorraphy. Both TPI and neurectomy have been suggested as treatment options, but evidence is conflicting. Patients with chronic neuropathic pain after primary Lichtenstein repair and >50% pain reduction after a diagnostic TPI were randomized for repeated TPI (combined Lidocaine/corticosteroids /hyaluronic acid injection) or for a neurectomy. Primary outcome was success (>50% pain reduction using Visual Analog Scale, VAS) after 6 months. Cross-over to neurectomy was offered if TPI was unsuccessful. A total of 54 patients were randomized in a single center between January 2006 and October 2013. Baseline VAS was similar (TPI: 55, range 10-98 vs neurectomy: 53, range 18-82, P = 0.86). TPI was successful in 22% (n = 6), but a neurectomy was successful in 71% (n = 17, P = 0.001). After unsuccessful TPI, 19 patients crossed over to neurectomy and their median VAS score dropped from 60 to 14 (P = 0.001). No major complications after surgery were reported. Two-thirds of patients on worker's compensation returned to work. A tailored neurectomy is 3 times more effective than tender point infiltration in chronic inguinodynia after anterior inguinal hernia mesh repair. A step up treatment stratagem starting with tender point infiltration followed by a tailored neurectomy is advised.

Factors associated with acute and chronic pain after inguinal herniorraphy.

The aim of this study was to analyse the relationship between types of anaesthesia, patients' demographic variables, preoperative emotional states and the prevalence of postoperative pain. In this randomized prospective study, postoperative pain was assessed in 100 patients, who were ASA (American Society of Anaesthesiologist) I-II and between 18-65 years old, undergoing inguinal herniorrhaphy with either general or spinal anaesthesia. In addition, postoperative pain compared with patients' demographic properties and psychological conditions in each group was also considered. Acute pain was evaluated at 1, 2, 4, 6, 12 and 24th hours with the Numerical Rating Scale (NRS) and chronic neuropathic pain was at 1, 2 and 3rd months with Douleur Neuropathique 4 Questions (DN4). All patients were treated with the same analgesics after operation. Group spinal anaesthesia had lower acute pain at 1 and 2nd hours but they felt more severe pain at the 24th hour. Also patients' anxieties were correlated with acute and chronic postoperative pain. Ten patients complained about postoperative chronic pain after 3 months and there was no significant difference between groups. Spinal anaesthesia decreased acute pain intensity at the first postoperative hours. Patients with anxiety felt high pain levels and they had an increased chronic pain prevalence.

Persistent pain following common outpatient surgeries in children: A multicenter study in Italy

The prevalence of persistent postsurgical pain in children is over 20% after major surgeries; however, data are scarce on the prevalence, character, and risk factors among children undergoing common ambulatory surgeries. The primary aim of this study was to evaluate the prevalence of persistent pain following pediatric ambulatory surgery at 1, 3, and 6months. Secondary aims were to identify risk factors and characterize the pain and consequences of persistent postsurgical pain. ASA I-II, ages 1 month to 16 years old, undergoing elective hypospadias repair, herniorraphy, orchiopexy, and orthopedic surgery were enrolled in a prospective, longitudinal, observational study at 3 pediatric centers in Italy. All patients received general plus regional anesthesia. Postoperative pain was evaluated using age appropriate pain scales at 1 and 3hours. At 1, 3, and 6months, pain scores were obtained and Parent's Postoperative Pain Measures (<8yo) and Child Activity Limitations Interview (>8yo) surveys were administered. About 350 patients completed the study. The prevalence of pain at 1, 3, and 6months was 24% (84/350), 6.0% (21/350), and 4.0% (14/350), respectively. Inguinal herniorraphy patients experienced significantly higher pain at all 3-time points; 35.6%, 14.9%, and 9.2%. There was no significant association between mean pain scores >4 in PACU and persistent pain. Pain persisting at 6months had neuropathic characteristics and frequently interfered with daily activities and sleep. Our data support the presence of persistent pain in pediatric patients after common surgeries. Most patients who developed persistent pain at 6months had pain at 1month. We recommend questioning at follow-up visit about persistent pain and functional impairment with follow-up until resolution.

Chronic Post Inguinal Herniorraphy Pain: Prevalence and Risk Factors

Background: Inguinal hernia is a common surgical condition. Whereas complications associated with hernia repair are well documented, chronic postoperative groin pain has received less attention. Objective: To review the frequency and associated risk factors for chronic post herniorrhaphy groin pain at a tertiary urban hospital. Methods: A retrospective descriptive study using data retrieved from patient files and theatre logs was conducted. Only inguinal herniae patients 13 years and above were considered. Pain was self reported at least 3months to 2 years after repair. Results: Eighty nine patient data were analyzed. Mean aged was 40.5years, Male:Female ratio was 6:1. Fifteen (17%) patients reported pain lasting &gt; 3 months. No significant age difference was noted between those with pain and the pain free. All those with chronic pain were male. Conclusion: Inguinodynia was common in this population. Post herniorraphy pain predictive risk factors in this population ought to be investigated.Keywords: Chronic Pain, Inguinal Hernia Repair, Pain, Surgery

Dedicated training lists can significantly improve traineeS' exposure to open inguinal herniorraphy

Dedicated training lists can significantly improve traineeS' exposure to open inguinal herniorraphy

Extrinsic Cecal Compression and Abdominal Pain Caused by a Migrated Inguinal Mesh Plug

AIM: To describe a case of extrinsic cecal compression and abdominal pain caused by a migrated inguinal mesh plug. CASE REPORT: A 59 yo male presented for surveillance colonoscopy, given a prior history of adenomatous colon polyps. His past medical history was unremarkable. From the surgical perspective, he had undergone prior right inguinal herniorraphy with polypropylene mesh inguinal plug placement several years previously. After informed consent was obtained, colonoscopy was performed under moderate sedation to the cecum with ileal intubation. The exam was unremarkable aside from there being and ˜ 1.5 cm area of extrinsic compression noted over the lateral wall of the cecum. The colon wall was able to be retracted from this area with grasping forceps, and overlying colon mucosa was normal and it was apparent that this finding was not related to an epithelial colon lesion. Given the endoscopic findings, a subepithelial intrinsic colon lesion was also thought to be unlikely. Upon reviewing the colonoscopic findings with the patient, he did endorse a 1 year history of aching and episodic right lower quadrant pain which had no precipitating, exacerbating or mitigating factors. A CT scan of the abdomen and pelvis was interpreted by the radiologist to be normal. The general surgeon who was consulted was concerned that there may have been migration of a previously placed inguinal mesh plug. Laparoscopy was recommended. At laparoscopy, a migrated inguinal mesh plug was found adherent to the cecum. The mesh plug was removed laparoscopically and the patient recovered uneventfully. His chronic aching abdominal pain resolved after 2 years of follow-up. CONCLUSION: Inguinal mesh plugs can rarely migrate into the abdomen and cause bowel complications. In the patient described in this report, laparoscopic removal of the migrated mesh plug was associated with durable resolution of chronic right lower quadrant pain.

Impact of concomitant hernia repair at the time of complete primary repair of bladder exstrophy

Inguinal hernias are common in the bladder exstrophy population. As these hernias may present with incarceration following bladder closure, several groups recommend inguinal exploration and hernia repair at the time of initial bladder closure. However, the benefits of such an approach are not well defined. In 2006, we modified our approach to this condition by routinely performing concomitant inguinal herniorraphy (CIH) repair at the time of initial exstrophy repair. The aim of this study was to test the hypothesis that simultaneous inguinal hernia repair will be safe and effective in reducing subsequent unplanned inguinal procedures in this high-risk group. We conducted a retrospective chart review of patients with classic bladder exstrophy managed with complete primary repair (CPRE) from 1990 to 2014, with focus on inguinal hernia repair at the time of bladder closure and subsequent need for inguinal surgery. We excluded patients with follow-up less than 6 months, missing data with regards to the initial inguinal approach at the time of bladder closure, and patients with intra-abdominal testicles. A total of 43 patients were included for analysis with 27 (61%) having inguinal hernias identified either at birth or in subsequent follow-up, including 20 of 27 boys and 7 of 16 girls. A summary of comparison groups with and without CIH at the time of CPRE, as well as follow-up and need for subsequent hernia repair, is given in the summary Table. Of 25 patients without concomitant inguinal herniorraphy at CPRE, 10 patients required subsequent inguinal surgeries for inguinal herniorraphy (seven), orchiopexy (one), or inguinal herniorraphy plus orchiopexy (two). CIH at the time of CPRE is safe, with no significant inguinal complications noted. Subsequent inguinal operations were more often required in the cohort of patients not receiving CIH at the time of CPRE, including one patient presenting with incarceration. Thus, CIH appears to reduce need for subsequent inguinal operations when performed at the time of bladder closure. Our study adds to other authors' claims that CIH should be attempted at the time of bladder closure. This study is limited by the retrospective nature of the review and differences in follow-up times between groups. Simultaneous inguinal hernia repair at the time of initial exstrophy repair is safe and associated with decreased incidence of subsequent inguinal surgery. Such an approach should be undertaken during initial bladder closure.

(397) Fluoroscopically-guided radiofrequency neurotomy technique for the treatment of genitofemoral neuralgia

Genitofemoral neuralgia (GFN) is a pain syndrome that causes burning, tingling, and numbness along the groin and medial thigh. The etiology is thought to be nerve entrapment or iatrogenic injury. GFN has been noted following surgeries such as inguinal herniorraphy, appendectomy, caesarian section, lymph node biopsy, hysterectomy, vasectomy, and urethral sling surgery. GFN has been treated with medications, surgical neurotomies, and with various ablative interventional procedures. These interventional procedures have been performed blindly, with CT guidance, or with ultrasound guidance. In this article we present the case of a 48-year-old-woman with GFN who responded to anesthetic nerve blockade of the genitofemoral nerve and subsequent fluoroscopically-guided genitofemoral radiofrequency neurotomy. She experienced complete relief of her symptoms immediately post-procedure and had 95% pain relief at 1.5 month-follow-up. To the knowledge of the authors, this is the first technical description of a fluoroscopic guidance technique for genitofemoral neurotomy.

A rare presentation of transverse testicular ectopia as an incarcerated inguinal hernia

Transverse testicular ectopia/crossed testicular ectopia is a rare but well-recognized entity in which both gonads migrate towards the same hemiscrotum. However, the initial presentation of this anomaly in an adult as an incarcerated inguinal hernia is extremely rare. In this report, we describe a 23-year-old male who presented to the emergency department of our hospital with a right incarcerated inguinal hernia. He underwent emergency surgical exploration and both the spermatic cords and testes were found in the right inguinal canal and hemiscrotum respectively. After surgical reduction for the incarcerated hernia and right inguinal herniorraphy, the right testis was fixed into the right hemiscrotum, and a left trans-septal orchiopexy was performed.