Abdominal Wall Surgical Procedures Associated with Lateral Femoral Cutaneous Syndrome
Inguinal hernia repair is the most common abdominal wall surgical procedure associated with lateral femoral cutaneous syndrome, with other procedures including iliac crest bone grafting, abdominoplasty, and laparoscopic approaches that involve manipulation near the anterior superior iliac spine. 1, 2, 3
Anatomical Considerations
- The lateral femoral cutaneous nerve (LFCN) typically exits the pelvis medial to the Sartorius muscle as a single branch, approximately 1.90 cm medial to the anterior superior iliac spine (ASIS) 3
- The LFCN can be found anywhere from 6.5 cm medial to the ASIS to 6 cm lateral to the ASIS, making it vulnerable during surgical procedures in this region 4
- The nerve travels within a complete fascial canal that starts at the inguinal ligament proximally and follows the nerve beyond its terminal branches 4
- Anatomical variations include the LFCN arising from the femoral nerve, duplicated nerves, and cases where the nerve rides directly over the ASIS 4
Surgical Procedures with Risk of LFCN Injury
Inguinal Hernia Repair
- Both open and laparoscopic inguinal hernia repairs (TAPP/TEP) can cause LFCN injury due to the nerve's proximity to the surgical field 5
- Prosthetic repair with synthetic mesh is the standard approach for inguinal hernia repair but increases risk of nerve entrapment 6
- Laparoscopic approaches, while offering advantages including reduced postoperative pain and faster recovery, still pose risk to the LFCN due to port placement and dissection near the nerve 6
Other Abdominal Wall Procedures
- Iliac crest bone grafting procedures frequently cause LFCN injury due to the nerve's variable course near the ASIS 2
- Abdominoplasty procedures risk LFCN injury during dissection of the abdominal wall 3
- Component separation technique for large midline abdominal wall hernias may affect the LFCN during lateral dissection 7
- Procedures involving the placement of drains or fixation devices near the ASIS increase risk of LFCN compression or injury 7
Prevention Strategies
- Maintain a distance of at least 3 cm from the ASIS when operating to prevent injury to the LFCN 3
- During inguinal hernia repair, careful identification and preservation of the nerve is essential, particularly during mesh placement 5
- When performing laparoscopic procedures, careful port placement away from the typical course of the LFCN can reduce injury risk 6
- In cases requiring extensive dissection near the ASIS, consider pre- or intraoperative imaging for better localization of the nerve 4
Management of LFCN Injury
- Surgical treatment is indicated only after failure of conservative management 1
- Surgical release of the nerve is the first-line surgical technique (92% of cases), with transection reserved for refractory cases (8%) 1
- Procedures can be performed under local anesthesia in most cases (83%) with good outcomes 1
- Surgical treatment leads to improvement and patient satisfaction in approximately 78% of cases 1
- Outcomes depend on etiology, duration of symptoms before intervention, and integrity of the nerve 1
Risk Factors for Poor Outcomes
- History of trauma or previous surgery (69% of cases with LFCN syndrome had such history) 2
- Hip replacement surgery (78% of post-surgical cases) 2
- Delayed surgical intervention after symptom onset 1
- Nerve transection rather than decompression 1
By understanding the variable anatomy of the LFCN and employing careful surgical technique during abdominal wall procedures, surgeons can minimize the risk of lateral femoral cutaneous syndrome and improve patient outcomes.