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Keywords:

  • gynaecological surgery;
  • nerve injury;
  • neuropathy

Key content

  • Nerve injuries are a common complication of gynaecological surgery, occurring in 1.1–1.9% of cases.
  • Patient mal-positioning, incorrect placement of self-retaining retractors, haematoma formation and direct nerve entrapment or transection are the primary causative factors in perioperative nerve injury.
  • Nerves most commonly injured during surgery include the femoral, ilioinguinal, pudendal, obturator, lateral cutaneous, iliohypogastric and genitofemoral nerves.
  • The majority of neuropathies resolve with conservative management and physiotherapy.
  • Selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants and gamma-aminobutyric acid (GABA) antagonists are of significant benefit in managing painful neuropathies.

Learning objectives

  • To gain an overview of the spectrum of different neuropathies that may occur following pelvic surgery.
  • To learn about safe surgical techniques in the prevention of postoperative neuropathies.
  • To review the clinical anatomy of the lumbo-sacral and brachial plexuses.

Ethical issues

  • Neuropathies can cause considerable postoperative morbidity.
  • Should neuropathies following gynaecology surgery be discussed routinely during consent taking?
  • Neuropathies following surgery may have considerable medico-legal implications.