Treatment of inguinodynia after laparoscopic herniorrhaphy - A combined laparoscopic and fluoroscopic approach to the removal of helical tackers

Laparoscopic inguinal herniorrhaphy has become a popular operation for the treatment of inguinal hernia. However, injury and entrapment of the cutaneous nerves of the lumbar plexus by the staples or tackers used for mesh fixation have been described. Laparoscopic removal of the staples or tackers in the inguinal region has been attempted with variable success. The success of the laparoscopic approach for removal of helical tackers in particular is sometimes limited by the fact that the offending tackers are deeply embedded in particular is sometimes limited by the fact that the offending tackers are deeply embedded in the preperitoneal tissues and not readily located with a sample laparoscopic view. The authors report a case in which fluoroscopy was used to help identify tackers that could not be visualized laparoscopically. The neuralgia disappeared after successful removal of the offending tackers with no neurologic deficit. Liberal use of the fluoroscopic guidance in the laparoscopic removal of helical takers in similar cases is recommended.