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Triple neurectomy

M F Bjurström, R Álvarez, A L Nicol, R Olmstead, P K Amid, D C Chen
PURPOSE: Neurectomy of the inguinal nerves may be considered for selected refractory cases of chronic postherniorrhaphy inguinal pain (CPIP). There is to date a paucity of easily applicable clinical tools to identify neuropathic pain and examine the neurosensory effects of remedial surgery. The present quantitative sensory testing (QST) pilot study evaluates a sensory mapping technique. METHODS: Longitudinal (preoperative, immediate postoperative, and late postoperative) dermatomal sensory mapping and a comprehensive QST protocol were conducted in CPIP patients with unilateral, predominantly neuropathic inguinodynia presenting for triple neurectomy (n = 13)...
January 13, 2017: Hernia: the Journal of Hernias and Abdominal Wall Surgery
Alexandra M Moore, Martin F Bjurstrom, Jonathan R Hiatt, Parviz K Amid, David C Chen
BACKGROUND: Refractory neuropathic inguinodynia following inguinal herniorrhaphy is a common and debilitating complication. This prospective study evaluated long-term outcomes associated with laparoscopic retroperitoneal triple neurectomy. METHODS: Sixty-two consecutive patients (51 male; mean age, 47); all failing pain management; prior reoperation in 35, prior neurectomy in 26; average follow-up 681 days (range: 90 days to 3 years). Measured outcomes include numeric pain ratings, dermatomal mapping, histologic confirmation, quantitative sensory testing, complications, narcotic usage, and activity level...
December 2016: American Journal of Surgery
Martin F Bjurström, Andrea L Nicol, Parviz K Amid, Christine H Lee, Francis M Ferrante, David C Chen
BACKGROUND: Chronic postherniorrhaphy inguinal pain (CPIP) is a complex, major health problem. In the absence of recurrence or meshoma, laparoscopic retroperitoneal triple neurectomy (LRTN) has emerged as an effective surgical treatment of CPIP. METHODS: This prospective pilot study evaluated the neurophysiological and clinical effects of LRTN. Ten consecutive adult CPIP patients with unilateral predominantly neuropathic inguinodynia underwent three comprehensive quantitative sensory testing (QST) assessments (preoperative, immediate postoperative, and late postoperative)...
June 23, 2016: Pain Practice: the Official Journal of World Institute of Pain
R Bendavid, W Lou, D Grischkan, A Koch, K Petersen, J Morrison, V Iakovlev
PURPOSE: The objective is to compare nerve densities in explanted polypropylene meshes in patients with or without chronic pain. Pain has supplanted recurrences as a complication of hernia surgery. The increased incidence of pain mirrors a parallel increase in the use of polypropylene meshes. Neither triple neurectomy nor careful nerve preservation has brought relief. Perhaps because we have forgotten that nerves, in response to some evolutionary mechanism, tend to regenerate, undergo changes imposed by prosthetic elements and architecture, mimicking entrapment and compartment syndromes...
June 2016: Hernia: the Journal of Hernias and Abdominal Wall Surgery
Masato Narita, Koki Moriyoshi, Keita Hanada, Ryo Matsusue, Hiroaki Hata, Takashi Yamaguchi, Tetsushi Otani, Iwao Ikai
INTRODUCTION: Orchialgia following inguinal hernia repair is rare complication and still challenging since there has been no established surgical treatment because of complexity of nerve innervation to the testicular area. Herein we report a case of postoperative orchialgia following Lichtenstein repair, which was successfully treated by mesh removal, orchiectomy and triple neurectomy. CASE PRESENTATION: A 65-year-old man was referred to our department because of chronic right orchialgia following Lichtenstein hernia repair...
2015: International Journal of Surgery Case Reports
Ndi Geh, Mike Schultz, Lynda Yang, John Zeller
Triple neurectomy of the iliohypogastric (IHN), ilioinguinal (IIN), and genitofemoral (GFN) nerves is an available treatment option for chronic groin pain when conservative measures are ineffective. This research study attempted to define the variability of IHN, IIN, and GFN by categorizing variation and establishing a relationship to clinically significant landmarks. 22 cadavers (43 specimens) were dissected. Age, gender, ethnicity, BMI, and pertinent medical history were recorded for each specimen. Nerve emergence, insertion, and split points were measured in relation to clinically significant landmarks...
October 2015: Clinical Anatomy
W Reinpold, A D Schroeder, M Schroeder, C Berger, M Rohr, U Wehrenberg
PURPOSE: Chronic inguinodynia is one of the most frequent complications after groin herniorrhaphy. We investigated the retroperitoneal anatomy of the iliohypogastric, ilioinguinal, genitofemoral, and lateral femoral cutaneous nerve to prevent direct nerve injury during hernia repairs and to find the most advantageous approach for posterior triple neurectomy. METHODS: We dissected the inguinal nerves in 30 human anatomic specimens bilaterally. The distances from each nerve and their entry points in the abdominal wall were measured in relation to the posterior superior iliac spine, anterior superior iliac spine, and the midpoint between the two iliac spines on the iliac crest...
August 2015: Hernia: the Journal of Hernias and Abdominal Wall Surgery
Scott A Farrell, Marie-Eve Clermont
BACKGROUND: Gynaecologists who are asked to assess patients with pain in the genital area are not generally trained to consider neurogenic causes for the pain, nor are they generally familiar with the surgical procedures that can eliminate this pain. CASE: A 54-year-old woman who had undergone multiple laparotomies for Caesarean section, abdominal hysterectomy, treatment of ovarian cysts, and lysis of adhesions through a transverse abdominal approach presented with a seven- to eight-month history of severe neuropathic left-sided groin, labial, and perineal pain...
February 2015: Journal of Obstetrics and Gynaecology Canada: JOGC, Journal D'obstétrique et Gynécologie du Canada: JOGC
J F M Lange, R Kaufmann, A R Wijsmuller, J P E N Pierie, R J Ploeg, D C Chen, P K Amid
PURPOSE: Tension-free mesh repair of inguinal hernia has led to uniformly low recurrence rates. Morbidity associated with this operation is mainly related to chronic pain. No consensus guidelines exist for the management of this condition. The goal of this study is to design an expert-based algorithm for diagnostic and therapeutic management of chronic inguinal postoperative pain (CPIP). METHODS: A group of surgeons considered experts on inguinal hernia surgery was solicited to develop the algorithm...
February 2015: Hernia: the Journal of Hernias and Abdominal Wall Surgery
Seung Hwan Han, Nam Su Chung, Do Young Park
Minimally invasive, aesthetic calf volume reduction procedures are considered to be relatively safe. Published complications are mostly transient, with minimal functional loss. We hereby report debilitating ankle plantar-flexion contracture after aesthetic calf volume reduction procedure by selective neurectomy, with magnetic resonance imaging analysis and surgical treatment outcomes of this complication. From 2009 to 2010, 11 patients (17 lower legs) were surgically treated for this complication. The average preoperative ankle contracture angle of all involved lower legs was -22 degrees (range, -5 to -30 degrees)...
July 2015: Annals of Plastic Surgery
Mark A Mahan, Andrew K Kader, Justin M Brown
BACKGROUND: Painful neuromas are a relatively common complication of hernia and abdominal wall surgery. OBJECTIVE: Surgical neurectomy has the potential to to provide durable relief for chronic pain; however, current surgical approaches are not without morbidity or anatomical challenges.We sought a surgical alternative. METHODS: In the treatment of a case of incapacitating inguinal pain, we performed an anterior transperitoneal approach using a surgical robot...
January 2014: Acta Neurochirurgica
David C Chen, Jonathan R Hiatt, Parviz K Amid
IMPORTANCE: With the technical success of tension-free inguinal herniorrhaphy, chronic groin pain has far surpassed recurrence as the most common long-term complication. OBJECTIVE: To evaluate laparoscopic triple neurectomy of the ilioinguinal, iliohypogastric, and genitofemoral nerve trunks in the retroperitoneal lumbar plexus for treatment of refractory inguinodynia. DESIGN: Prospective study. SETTING: University hernia center...
October 2013: JAMA Surgery
Josef E Fischer
Fifteen to 20 years ago, transversalis and Shouldice Hospital repairs were standard, with a 4% to 6% rate of recurrence. With a focus on recurrence, various mesh repairs were proposed to reduce the incidence of recurrence. With these repairs, an increased incidence of inguinodynia due to the entrapment of the nerves proximate (adjacent) to the mesh has been observed. Many surgeons doubted its existence; however, there is sufficient evidence that with mesh repair in which the affected nerves are resected, the incidence of severe pain is lessened considerably...
October 2013: American Journal of Surgery
G Campanelli, V Bertocchi, M Cavalli, G Bombini, A Biondi, T Tentorio, C Sfeclan, M Canziani
BACKGROUND: Chronic groin pain is defined as pain arising 3-6 months after inguinal hernia repair that can compromise the patient's quality of life. Many articles in the literature report clinical presentation, but there are no well-defined indications and protocols of treatment. METHODS: Forty-six patients underwent surgical treatment for chronic groin pain that consisted of a simultaneous double approach, anterior and posterior, to the inguinal region, with 44 triple neurectomies and 2 iliohypogastric neurectomies...
June 2013: Hernia: the Journal of Hernias and Abdominal Wall Surgery
Craig M Kline, Charles E Lucas, Anna M Ledgerwood
BACKGROUND: Chronic neurogenic pain after surgery, especially inguinal herniorrhaphy, remains a major cause of morbidity. The traditional treatment of postinguinal herniorrhaphy neurogenic pain has included triple neurectomy with the removal of any mesh. This report describes a directed, minimally invasive surgical neurectomy that provided pain relief in 28 patients with minimal morbidity. METHODS: After temporary but successful proximal peripheral nerve blockade, the nerve was blocked in the operating room using a small amount of blue dye mixed with the local anesthetic...
March 2013: American Journal of Surgery
Margarita Juárez, Isela Hernández, Yolanda Cruz
AIMS: To determine the contribution of the striated musculature anatomically related to the urethra on urinary continence in conscious male rats. We tested whether the bilateral neurectomy of the motor branch of the sacral plexus (MBSP), a nerve that innervates the bulbospongiosus, ischiocavernosus, and external urethral sphincter, is a reliable procedure to induce changes in voiding pattern that can be used as indicators of urinary incontinence in unanesthetized male rats. METHODS: Micturition behavior was videotaped and urinary parameters measured 24 h before and at day 2 and 10 after surgery...
November 2012: Neurourology and Urodynamics
Parviz K Amid, David C Chen
BACKGROUND: Standard triple neurectomy does not address inguinodynia secondary to neuropathy of the genitofemoral nerve and the preperitoneal segment of its genital branch seen after inguinal hernia repair performed laparoscopically or in open preperitoneal fashion. STUDY DESIGN: Standard triple neurectomy was extended to include the genitofemoral nerve. Sixteen patients with chronic groin pain after laparoscopic and open preperitoneal inguinal hernia repair underwent operative triple neurectomy, with resection of the main trunk of the genitofemoral nerve in the retroperitoneum over the psoas muscle...
October 2011: Journal of the American College of Surgeons
Jae W Song, J Stuart Wolf, John E McGillicuddy, Sandeep Bhangoo, Lynda J-S Yang
BACKGROUND: Neuropathic groin pain can be a severely debilitating condition. Triple neurectomy of the ilioinguinal, iliohypogastric, and genitofemoral nerves is a viable treatment option. OBJECTIVE: To present our initial experience with the laparoscopic retroperitoneal approach to triple neurectomy. METHODS: Three patients (33 to 48 years of age) presented with chronic groin pain of 3 to 7 years' duration. The discomfort manifested in the ilioinguinal, iliohypogastric, and genitofemoral nerve distributions and severely affected their lifestyles, resulting in multiple unsuccessful medical and surgical treatments without symptomatic relief...
June 2011: Neurosurgery
D H de Lange, A R Wijsmuller, T J Aufenacker, J A Rauwerda, M P Simons
Two male patients, aged 37 and 56, suffered from neuralgic pain after a Lichtenstein procedure for inguinal hernia repair using prosthetic reinforcement. Since mesh-based repair techniques have decreased the recurrence rate, postoperative inguinal pain has become a major complication of these operations. Three months after surgery, 20% of the patients experience some pain. In 12% of the patients this pain limits daily activities and 1-3% of the patients are invalidated by neuralgic pain. Preventing damage to sensory nerves during the operation is one way of preventing neuralgic pain...
October 11, 2008: Nederlands Tijdschrift Voor Geneeskunde
George S Ferzli, Eric Edwards, Georges Al-Khoury, RoseMarie Hardin
Groin pain following inguinal hernia repair remains a challenge to most general surgeons. Prevention of groin pain may be the most effective solution to this management problem and necessitates careful anatomic dissection and precise knowledge of surgical anatomy of the groin as well as potential pitfalls of surgical intervention. When complications arise, a period of watchful waiting is warranted, but surgical intervention with triple neurectomy offers the most definitive resolution of symptoms. This article aims to provide a thorough review of pertinent anatomic landmarks for the proper identification of the nerves that, if injured, result in chronic groin pain and to provide a treatment algorithm for patients suffering with this morbidity...
February 2008: Surgical Clinics of North America
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