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The technique of laparoscopic inguinal hernia repair has been developed to reduce the discomfort and recovery time following herniorrhaphy '. The method employed by the authors is to raise superior and inferior peritoneal flaps, excise any indirect sac and insert a 127 x 76 mm polypropylene mesh to cover the internal ring and posterior wall of the inguinal canal. The mesh is secured along its superior, lateral and medial borders by vitallium staples (Fig. I). The peritoneum is closed with staples. This technique has been described previously'.Three patients in a series of 60 laparoscopic herniorrhaphies subsequently developed meralgia paraesthetica. Case reports Patient IThe eighth patient in the series underwent bilateral herniorrhaphy. On the second day after operation he complained of severe bilateral anterolateral thigh pain. There was marked hyperpathia in the distribution of the lateral cutaneous nerves of the thigh, with a positive Tinel sign on tapping over the lateral ends of the inguinal ligaments. After 3 months the hyperpathia in the left thigh had not diminished and the lateral cutaneous nerve of the thigh was released by excising the superolateral comer of the mesh. Patient 2The second case involved a 20-year-old man who had an indirect right inguinal hernia repaired laparoscopically. Over the next 48 h he developed pain in the lateral aspect of the right thigh. The pain resolved over 2 weeks, but at 6 weeks the patient still had altered sensation in the affected area. Pnrient 3The 19th patient in the series also developed meralgia paraesthetica following laparoscopic inguinal hemiorrhaphy. This resolved completely within 6 weeks. Paper accepted 23 September 1993 \ _ E i Lateral \\\ \ Inferior epigastric Polypropylene / ligament cutaneous nerve of A\ \ I\ External thigh . iliac 3 vessels mesh Fig. 1 Intraperitoneal aspect of the inguinal region showing the placement of the polypropylene mesh and its relationship to the lateral cutaneous nerve of the thigh as it traverses the inguinal ligament DiscussionThe posterior divisions of L2 and L3 form the lateral cutaneous nerve of the thigh which pierces the inguinal ligament at its lateral end (Fig. I) to supply the anterolateral and lateral aspects of the thigh3.Compression of this sensory nerve causes the condition known as meralgia paraesthetica, which presents as a burning pain, paraesthesia and hyperpathia in the area of distribution4. The commonest cause is entrapment of the nerve as it passes through the inguinal ligament or penetrates the deep fascia of the thigh4.The lateral cutaneous nerve of the thigh is vulnerable during dissection or stapling at the lateral end of the inguinal ligament. O n reviewing the technique, the authors now trim 15 mm from the long axis of the mesh and limit the position of the staples to 1 cm lateral to the internal ring. Since adopting this approach no further instances of meralgia paraesthetica have been encountered. This modification is recommended to other surgeons performing laparoscopic herniorrhaphy.

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