The cutaneous nerves encountered during laparoscopic repair of inguinal hernia: new anatomical findings for the surgeon.

Background: With an incidence rate of 2%, injury to the nerves of the lumbar plexus is the most common complication of laparoscopic hernioplasty, particularly when the transabdominal preperitoneal (TAPP) technique is used.

Methods: The course of the genitofemoral nerve, lateral femoral cutaneous nerve, and ilioinguinal nerve within the operation site was investigated in 53 adult dissecting-room bodies. Their relationship to the deep inguinal ring, iliopubic tract, and anterior superior iliac spine was also examined.

[The venae cavae and their major inflow. Anastomotic valve relations and endothelial abnormalities].

The site and condition of the valves at the junctions of the venae cavae and their tributaries were determined, abnormal endothelial structures identified and the vessel calibre measured in sections through the superior venae cavae of 122 and of the inferior venae cavae of 107 adults. A scale diagram of the venae cavae shows variations of the valve position and occurrence of abnormal endothelial structures in the brachiocephalic veins and the inferior vena cava. These structures might present a hazard for central venous catheterization and introduction of a vena cava filter.

The portal bifurcation and the termination of the hepatic veins: an anatomical investigation into the projection of the ultrasonographically important hepatic vessels onto the anterior body wall.

An investigation was carried out on 50 cadavers, in which the projection onto the anterior abdominal wall of the following vascular points was examined: the portal bifurcation, the direction of the course of the right and left branches of the portal vein and the terminal course of the hepatic veins near their entry into the inferior vena cava (IVC). The results are related to a transverse axis passing through the apex of the xiphoid process and the median plane in the supine position. The average position of the portal bifurcation is projected onto a point between a vertical line passing through the midpoint of the right hemithoracic width and a horizontal line passing through a point on the midclavicular line (MCL) corresponding to 57% of the height of the liver measured upwards from its inferior margin.

[Disorders of microcirculation in colon anastomoses and their significance for the pathogenesis of suture dehiscence].

In this morphologic experimental study in the rabbit disturbances in the microcirculation at the site of colonic anastomoses were found in all suture techniques employed. They are caused by resection, intraoperative traumatization, the suture technique, and, secondarily, by abscess formation on the anastomosis. The suture-induced disturbances of the microcirculation lead to necroses of the mucosa, partial and complete necroses of the inverted cuff, and transmural necroses with destruction of the sero-serous contact zone.

The iliohypogastric and ilioinguinal nerves. Distribution in the abdominal wall, danger areas in surgical incisions in the inguinal and pubic regions and reflected visceral pain in their dermatomes.

The courses of the iliohypogastric and ilioinguinal nerves were studied in 44 adult human cadavers, in order to clarify their relations to incisions in the abdominal wall in appendectomy, inguinal hernial repair, caesarean section and lumbar nephrectomy. If either of these nerves is trapped during suturing of the abdominal layers, especially after inguinal hernia repair and appendectomy typical nerve irritation in the inguinal region is observed. To avoid cutting the anterior branches of the iliohypogastric and ilioinguinal nerves in appendectomy, incisions should be placed at a distance of not less than 3 cm from the anterior superior iliac spine.