The laparoscopic approach is becoming a widely used technique for appendectomy. It is considered to be as safe as traditional surgery, with few complications. It is especially indicated in young women for diagnostic and aesthetic reasons. Various techniques currently are available that differ in the number of trocars and the site of insertion [1, 2, 3]. We report a case of meralgia paresthetica caused by laparoscopic appendectomy.

Case report

A young woman (age, 23 years) with acute appendicitis underwent laparoscopic surgery. The surgical intervention was performed with the patient under general anesthesia. Pneumoperitoneum was obtained with periumbilical incision, and after video laparoscope placement, two trocars were inserted. The first trocar was suprapubic and the second was placed in the right lower abdominal quadrant above the iliac crest. The surgical procedure was completed without any reported complication.

When the patient woke up, she immediately reported paresthesia and dysesthesia on the anterolateral side of her right thigh. One month later, the symptoms had not changed. Therefore, the patient was referred to our hospital for neurologic evaluation and electromyography (EMG). Her surgical scars had a normal aspect, but the one in the right lower abdominal quadrant, located just above the iliac crest, was painful to touch, with pain irradiation on the anterolateral side of the right thigh. There also was ipoesthesia and spontaneous paresthesia with a certain degree of allodynia in the same region. The knee jerks were symmetric, and there was no difference in muscle strength between the thighs.

At the EMG, the sensory action potential from the right femorocutaneous lateral nerve was not elicitable. On the contrary, it was normal on the left side. The compound muscle action potential from the right femoral nerve and motor unit action potentials from right vastus lateralis muscle were normal.

A diagnosis of meralgia paresthetica was posed, and specific treatment (local infiltration with anesthetics and oral gabapentin (1,200 mg/dy) and amythriptiline (50 mg/dy) was administered, with partial benefit. After 3 months of treatment, the patient’s symptoms had not completely resolved.

Discussion

To date, this is the first report of femorocutaneous lateral nerve damage resulting from an appendectomy performed with a laparoscopic technique. Meralgia paresthetica caused by laparoscopic procedure was previously described after cholecystectomy [5].

The superficial position of the femorocutaneous lateral nerve exposes this structure to frequent involvement in traumatic lesions caused accidentally or by medical manoeuvres. In the case of laparoscopic procedures, although meralgia paresthetica is not reported as a frequent complication, attention should be paid to the site of trocar insertion in relation to possible nerve damage.

We believe that in the reported case, trocar insertion in the right lower abdominal quadrant too close to the iliac crest was the cause of the nerve damage, with subsequent neuralgic syndrome. Usually, meralgia paresthetica is a benign and self-limited pathology, but sometimes symptoms have not been relieved several months after injury, and the neuropathic pain syndrome resulting from nerve lesion is somewhat difficult to treat. Surgical revision with neurolysis or nerve transection [4] may be necessary.