Bleeding/Vascular Injury
In the event of bleeding, it is advisable to initially use suction and irrigation to maintain a clearer view of the site and to reliably identify the source of bleeding. If clips are necessary, a 5mm trocar can be replaced with a 10mm one. If visibility is poor, conversion to open surgery is required.
- No staples in the "triangle of doom" (vessels), an anatomical triangle defined by the vas deferens medially, the spermatic vessels laterally, and the peritoneal fold below.
- Bleeding from the femoral vessels leads to massive blood loss with clinical hypovolemic shock in a short time. The bleeding must be detected and the source sutured, possibly requiring conversion and the involvement of a vascular surgeon.
- Injury to the epigastric vessels during balloon dissection, suturing of the peritoneum, or parietalization may require these vessels to be clipped.
- In the case of iatrogenic venous injury and subsequent thrombosis of the femoral vein in the operative area, it is a thrombosis of the pelvic level.
- Diagnostics: Duplex and Doppler sonography or phlebography
- Treatment of deep vein thrombosis: Compression, mobilization, full heparinization (beware of the risk of rebleeding!).
- For further information, please follow the link to the current guideline: Prophylaxis of venous thromboembolism (VTE).
Irritation, Constriction, or Injury of Inguinal Nerves with Postoperative Persistent Pain
- Particularly at risk are the lateral femoral cutaneous nerve and genitofemoral nerve in the "triangle of pain" (an inverted V whose apex corresponds to the internal inguinal ring, with the upper anterior limb formed by the iliopubic tract or inguinal ligament, and the medial posterior by the spermatic vessels).
- Significantly lower in minimally invasive procedures
- Traumatic nerve damage during preparation, suturing, or pinching of nerves in staples during mesh fixation.
- Fixation of the mesh with glue reduces the frequency of pain compared to fixation with staples.
Injury to the Vas Deferens
If there is an injury to the vas deferens, the following aspects are crucial for further action: Was the vas deferens completely or only partially transected? How old is the patient? Does the patient have a desire for children?
In sexually inactive older patients, the vas deferens may be transected if necessary. In any case, the patient must be informed postoperatively about what happened and what the consequences are for him.
Bowel Injury (< 1%)
Recognized bowel lesions or coagulation damage are oversewn laparoscopically.
Bladder Injury (< 1%)
Bleeding from the retropubic plexus increases the risk of bladder injury.
In the event of a bladder injury, the injured site must be oversewn. Postoperatively, the bladder is decompressed for 1 week using a suprapubic fistula catheter (SPC) or Foley catheter.