Laparoscopic plug removal for femoral nerve colic pain after mesh & plug hernioplasty

BACKGROUND Inguinal hernias account for 75% of abdominal wall hernias, with a lifetime risk of 27% in men and 3% in women. Major complications are recurrence, chronic pain, and surgical site infection, but their frequency is low. Few studies have reported a calcified mesh causing neuropathy by chronic compression of the femoral nerve after mesh & plug inguinal hernia repair. This is the first report of laparoscopic plug removal for femoral colic due to femoral nerve irritation cause by a calcified plug after mesh & plug inguinal hernia repair. CASE PRESENTATION In July 2013, a 53-year-old man presented to our hospital with a chief complaint of colic pain in the left lower limb while walking. The patient had undergone left inguinal hernia repair about 10 years earlier and reported no chronic pain after the operation. Physical examination revealed a colic pain exacerbated by left thigh movement, especially during flexion, but the patient was pain-free at rest and had no sensory loss. Axial computed tomography and magnetic resonance imaging showed that the inward-projecting plug was extremely close to the femoral nerve. Because of the radicular symptoms and the absence of orthopedic and urological disease, we strongly suspected that the neuralgia was associated with the previous hernia operation and advised exploratory laparotomy, which revealed the plug bulging inward into the abdominal cavity. Moreover, the tip of the plug was firmly calcified and compressing the femoral nerve, which lay just beneath the plug, especially during hip flexion. We explanted the plug and his pain resolved after the operation. The patient remains pain free after 20 months of follow up. CONCLUSION In this study, laparoscopic hernioplasty proved useful for plug removal because laparoscopic instruments can easily grasp perilesional tissue, and laparoscopic approach has the benefit of isolating the plug for removal while preserving the onlay patch, and helpful for restoring peritoneal defects. Laparoscopic plug removal effectively resolved colic pain in the left thigh due to compression of the femoral nerve by a calcified plug.