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Background Neuropathic inguinodynia following inguinal hernia repair sometimes becomes a disabling disease. We report a case of successful surgical treatment of chronic refractory neuropathic pain after inguinal hernia by laparoscopic retroperitoneal triple neurectomy. Case presentation A seventy-year-old male who underwent right-side inguinal hernia repair using the Lichtenstein method revisited our hospital with inguinodynia 16 months after surgery. After a thorough assessment, the patient was diagnosed with neuropathic pain based on the following: 1) dermatomal mapping suggested ilioinguinal and iliohypogastric nerve problems, 2) pain was evoked by specific movement, 3) the site of maximum pain was slightly changed at every physical examination, and 4) no evidence of recurrence or meshoma was observed on MRI. Conservative therapies were ineffective. Surgical intervention using laparoscopic retroperitoneal triple neurectomy was performed 4 months after treatment initiation. In the lateral recumbent position, a three-port method was used. The ilioinguinal and iliohypogastric nerves and the genital branch of the genitofemoral nerves were identified and resected. Although a residual nerve emerged from L2/3 toward the inguinal region, the nerve remained in situ. Pain assessment 3 h after surgery revealed that pain was decreased but remained. Reoperation involving resection of the residual nerve was performed on the same day. Although another type of mild pain appeared 3 months after surgery, the patient resumed normal life, without any restrictions. Conclusions Laparoscopic retroperitoneal triple neurectomy is useful for treating refractory neuropathic pain. The diagnosis of neuropathic pain via thorough preoperative assessment is vital for procedure success because the procedure would not be effective for other types of pain. [ABSTRACT FROM AUTHOR]

Introduction Laparoscopic intraperitoneal onlay mesh (IPOM) repair is occasionally used for inguinal hernia repair. Here, we report a case of chronic neuropathic pain after laparoscopic IPOM repair for inguinal hernia, which was treated successfully with laparoscopic selective neurectomy. Presentation of case A 59-year-old man with bilateral inguinal hernia underwent laparoscopic repair. Transabdominal preperitoneal repair was performed on the left side, whereas IPOM repair was performed on the right side due to a peritoneal defect. At postoperative month 1, he presented with severe pain and numbness distributed from the right inguinal region to the inner thigh region. The symptoms had persisted for 1 year despite medical treatment. We diagnosed that the symptoms might be due to the entrapment of nerves in the contracted mesh, and performed a second surgery via laparoscopic approach 13 months after the first surgery. On laparoscopic exploration, the lateral side of the mesh was contracted and involved nerve branches. We ligated and cut off these nerve branches. His symptoms resolved immediately after the surgery. At postoperative month 12, he has passed without any pain, numbness, and hernia recurrence. Discussion Laparoscopic exploration would be useful to figure out chronic neuropathic pain after laparoscopic inguinal hernia repair. Conclusion Laparoscopic IPOM repair for inguinal hernia should be avoided as much as possible because it may cause chronic neuropathic pain. Laparoscopic selective neurectomy is an option for patients with chronic neuropathic pain after laparoscopic hernia repair. [ABSTRACT FROM AUTHOR]

Introduction Orchialgia following inguinal hernia repair is rare complication and still challenging since there has been no established surgical treatment because of complexity of nerve innervation to the testicular area. Herein we report a case of postoperative orchialgia following Lichtenstein repair, which was successfully treated by mesh removal, orchiectomy and triple neurectomy. Case presentation A 65-year-old man was referred to our department because of chronic right orchialgia following Lichtenstein hernia repair. He walked with a limp and was unable to walk a long distance. Physical examination revealed the presence of meshoma in the groin area and hypoesthesia in the anterior skin of the right scrotum. His right testis was completely atrophic and located not in the scrotum but in the subcutaneous regions of right groin. He was diagnosed as both neuropathic and nociceptive orchialgia and underwent meshoma removal, triple-neurectomy, and orchiectomy to address these issues. Pathological examination revealed that meshoma was integrated with the structures of the spermatic cord, leading to foreign-body reaction and fibrosis around the genital branch of genitofemoral nerve. The resected right testis was completely-scarred without ischemic changes. Orchialgia disappeared immediately after operation and he was able to walk without a limp. Discussions It is important to distinguish between nociceptive and neuropathic orchialgia. Neuroanatomic understanding is essential to guide treatment options. Orchiectomy is an option but should be reserved for refractory cases with evidence of nociceptive pain accompanied by anatomical changes. Conclusions Triple neurectomy should be considered in patients with neuropathic orchialgia. [ABSTRACT FROM AUTHOR]

Introduction There have been few reports on the prognosis of patients with intraductal papillary neoplasms of the bile duct (IPNB). Here we report a case of IPNB in a patient with early-stage carcinoma who had multicentric recurrence in the remnant hepatic bile duct after curative resection. Case presentation A 78-year-old man with hepatic dysfunction and cholestasis was referred to our hospital. Preoperative imaging studies revealed the presence of papillary tumors in the left hepatic duct and common hepatic duct, while no tumor lesions were detected in the right hepatic duct. This patient underwent left hepatectomy, extra-hepatic bile duct resection with biliary reconstruction, and regional lymphnode dissection. On the basis of pathological examination, this patient was diagnosed with multiple IPNB with early-stage adenocarcinoma with negative surgical margin. Postoperative work-up was periodically performed, indicating no evidence of recurrence, while the patient had sustained hepatic dysfunction, cholestasis, and repetitive cholangitis since the early postoperative period. Finally, recurrence in the remnant intrahepatic bile duct of the posterior segment was revealed by double balloon enteroscopy at 29 months after surgery. At 34 months after surgery, internal drainage stents were replaced in both endoscopic and percutaneous manners within the relapsed intrahepatic bile ducts to address repetitive cholangitis. These procedures enabled the patient to remain asymptomatic until death at 41 months after surgery. Discussion Multicentric recurrence in the remnant intrahepatic bile duct after surgery may occur in IPNB patients with multiple lesions. An endoscopic approach may be useful in such cases, not only in the diagnosis of remnant intrahepatic bile duct recurrence but also for palliation of symptoms. [ABSTRACT FROM AUTHOR]

INTRODUCTION Vascular complications following hepato-pancreatic biliary surgery can be devastating, and therefore precaution of them must be critical. We report two cases in which the pedicled omental transposition flap might be effective to avoid postoperative venous complications following major hepatectomy. PRESENTATION OF CASE Case 1 is a 80-year-old male who required to perform re-laparotomy at postoperative day 1 following major hepatectomy due to acute portal venous thrombosis (PVT). In the second surgery, the main trunk of PV was occluded by thrombus resulted from its redundancy and kinking. PV was resected with an adequate length and reconstructed. The omental flap was placed between PV and inferior vena cava (IVC) to fill in the dead space, resulting in favorable intrahepatic portal blood flow. Case 2 is a 64-year-old male who underwent left trisectionectomy because of giant hepatocellular carcinoma located close to the trunk of right hepatic vein (RHV) and IVC. After removal of the specimens, the dead space developed between the RHV and IVC. In order to prevent outflow block caused by kinking of the RHV, the omental flap was placed between the RHV and IVC, and the right triangle ligament of the liver was fixed to the diaphragm. RHV patency was confirmed by postoperative imaging. DISCUSSION The omental flap is a simple procedure and useful to fill the dead space developed in the area surrounding major vessels. CONCLUSIONS We experienced two cases in which vascular complications might be avoided by filling the dead space surrounding major vessels using the omental flap. [ABSTRACT FROM AUTHOR]