FEMORAL NERVE DAMAGE AFTER ABDOMINAL RECTOPEXY

Iatrogenic femoral nerve damage has already been described after hyste rectomy, but never after abdominal rectopexy. We report the occurrence of femoral nerve injury in six of twenty-four patients operated on fo r complete rectal prolapse (n = 21) or rectorectal intussusception (n = 3). Four patients had unilateral and two bilateral lesions. All six patients had clinical and electromyographic (EMG) assessment. EMG find ings were given a score from 0 (complete denervation) to 5 (normal fin dings). During the immediate postoperative period all patients complai ned of reduced cutaneous sensation of the anterior surface of the thig h and knee, and quadriceps weakness. EMG showed complete denervation i n one patient, marked denervation in three, and slight or moderate den ervation in the remaining two. In five patients there was complete cli nical resolution at 3 to 12 months postoperatively, while one showed a n improvement only. EMG control performed in four patients showed a fu ll recovery in three. Two patients refused this examination. We believ e femoral nerve damage was caused by the large-bladed self-retaining r etractors used, which directly or indirectly compressed the femoral ne rve.