Abdominal Wall Nerve Injury During Laparoscopic Gynecologic Surgery: Incidence, Risk Factors, and Treatment Outcomes

Study Objective: To determine the incidence and clinical significance of iliohypogastric-ilioinguinal neuropathy from lower abdominal lateral port placement and fascial closure during laparoscopic gynecologic surgery. Design: Retrospective cohort study (Canadian Task Force classification II-2). Setting: University-based referral center specializing in minimally invasive gynecologic surgery and chronic abdominopelvic pain. Patients: Women who underwent a laparoscopic procedure because of benign gynecologic indications during a 3-year study period from 2008 to 2011. A total of 317 women met study criteria. Interventions: Operative laparoscopy using a lateral port in the lower abdomen. Closure of port-site fascial defects was achieved using either a Carter-Thomason or EndoClose suture device. Measurements and Main Results: Nerve injury was identified by symptoms, and was confirmed with a nerve block after a positive test for allodynia in the distribution of the iliohypogastric-ilioinguinal nerve. Of 173 cases that did not involve fascial closure of a port-site defect, none were associated with nerve injury. Of 144 cases that involved fascial closure, 7 (4.9%) included nerve injury that resulted in pain requiring treatment (p = .004). In 1 patient, symptoms improved with medical management alone. Six patients required surgical management, and 5 of them had resolution of pain after removal of the fascial suture. There was no statistically significant difference in the incidence of nerve injury between the Carter-Thomason and EndoClose groups (4.7% vs 5.4%; p = .87). Conclusions: There is an estimated 5% risk of clinically significant postoperative neuropathic pain due to injury of the iliohypogastric-ilioinguinal nerve with fascial closure of laparoscopic incisions in the lower abdomen. Pain seems to be due to suture entrapment of sensory fibers because it is usually resolved by removal of the suture. Prompt recognition and treatment may prevent subsequent development of chronic abdominopelvic pain.