What causes vascular injury in open inguinal hernia repair?

Updated: Jan 17, 2018
  • Author: Vinay Kumar Kapoor, MBBS, MS, FRCS, FAMS; Chief Editor: Kurt E Roberts, MD  more...
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Answer

Superficial epigastric vessels in the incision may bleed. These vessels not only should be identified when the incision is being made but also should be ligated and divided. Inferior epigastric vessels may be injured during dissection of the spermatic cord in the inguinal canal, dissection of an indirect inguinal hernia sac within the spermatic cord, plication of the transversalis fascia, or transfixion of the hernial sac. These vessels should be identified at an early stage and protected.

External iliac or femoral vessels, especially veins, may be injured during fixation of the mesh to the inguinal ligament in its lateral part. The tissue bites in the inguinal ligament should not be very deep.

Although less common than other intraoperative complications, vascular injuries are potentially disastrous. They can be avoided by respecting the proximity of the femoral vessels, particularly when suturing the mesh to the inguinal ligament. Hematoma formation can result from injury of the inferior epigastric vessels or pampiniform plexus veins or from failure to ligate the superficial subcutaneous veins.


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