Femoral nerve damage after abdominal rectopexy

Abstract

Iatrogenic femoral nerve damage has already been described after hysterectomy, but never after abdominal rectopexy. We report the occurrence of femoral nerve injury in six of twenty-four patients operated on for complete rectal prolapse (n = 21) or rectorectal intussusception (n = 3). Four patients had unilateral and two bilateral lesions. All six patients had clinical and electromyographic (EMG) assessment. EMG findings were given a score from 0 (complete denervation) to 5 (normal findings). During the immediate postoperative period all patients complained of reduced cutaneous sensation of the anterior surface of the thigh and knee, and quadriceps weakness. EMG showed complete denervation in one patient, marked denervation in three, and slight or moderate denervation in the remaining two. In five patients there was complete clinical resolution at 3 to 12 months postoperatively, while one showed an improvement only. EMG control performed in four patients showed a full recovery in three. Two patients refused this examination. We believe femoral nerve damage was caused by the large-bladed self-retaining retractors used, which directly or indirectly compressed the femoral nerve.

Peripheral Neuropathy after Open Abdominal Surgery with Self-Retaining Retractors. A Systematic Review of Randomised and Non-Randomised Clinical Trials

“…Of these cases, two were chosen not to be included in the statistical summaries. One paper [10] only had two cases considered and the Five articles looked at the femoral nerve damage that was most likely caused by the retractors used during surgery [7] [8] [9] [10] [12]. Two surgeries looked at retractor used specifically with obese patients [6]- [13].…”

“…Within this requirement, a wide range of surgeries have been encompassed. These include tumour resection [8] [11], caesarean section [5] [6], hysterectomy [7], abdominal rectopexy [9] and general pelvic surgeries [10] [12]…”

“…In the five articles which looked at femoral neuropathies, the main outcome measure was whether the patient experienced femoral neuropathy following surgery [7] [8] [9] [10] [12]. In some cases, data were also collected as to whether the neuropathy subsided or continued to be an issue even years later [9].…”

“…In some cases, data were also collected as to whether the neuropathy subsided or continued to be an issue even years later [9].…”

“…One was a randomized controlled trial [7], one was a retrospective study [12] and two articles had both retrospective and prospective data in them [8] [9]. One was a case study of two cases and has been excluded from this discussion [10].…”