Advertisement

Hernia

, Volume 8, Issue 4, pp 343–349 | Cite as

Causes, prevention, and surgical treatment of postherniorrhaphy neuropathic inguinodynia: Triple neurectomy with proximal end implantation

  • P. K. Amid
Original Article

Abstract

The recommended surgical treatment for chronic neuropathic pain after herniorrhaphy has been a two-stage operation including: (a) ilioinguinal and iliohypogastric neurectomies through an inguinal approach and (b) genital nerve neurectomy through a flank approach. Two hundred twenty-five patients underwent triple neurectomies with proximal end implantation to treat chronic postherniorrhaphy neuralgia. Four patients reported no improvement. Eighty percent of patients recovered completely, and 15% had transient insignificant pain with no functional impairment. These results are comparable to the results of the two-stage operation. Simultaneous neurectomy of the ilioinguinal, iliohypogastric, and genital nerves without mobilization of the spermatic cord is an effective one-stage procedure to treat postherniorrhaphy neuralgia. It can be performed under local anesthesia and avoids testicular complications. Proximal end implantation of the nerves prevents adherence of the cut ends to the aponeurotic structures of the groin, which can result in recurrence of the pain. A one-stage surgical procedure resecting all three nerves from an anterior approach avoids a second operation through the flank and successfully treats chronic neuralgia.

Keywords

Postherniorrhaphy neuropathic pain Postherniorrhaphy chronic pain Meshoma Triple neurectomy for postherniorrhaphy chronic pain 

References

  1. 1.
    Moosman DA, Oelrich TM (1977) Prevention of accidental trauma to the ilioinguinal during the inguinal herniorrhaphy. Am J Surg 133:146–148CrossRefPubMedGoogle Scholar
  2. 2.
    Warwick R, Williams PL (eds) (1973) Gray’s Anatomy. WB Saunders, Philadelphia, PA, pp 1050–1053Google Scholar
  3. 3.
    Starling JR, Harms BA, Schroeder ME, Eichman PI (1987) Diagnosis and treatment of genitofemoral and ilioinguinal entrapment neuralgia. Surgery 102:581–586PubMedGoogle Scholar
  4. 4.
    Amid PK, Lichtenstein IL (1998) Long-term result and current status of the Lichtenstein open tension-free hernioplasty. Hernia 2:89–94Google Scholar
  5. 5.
    Amid PK (2004) Radiological images of “meshoma”: A recently recognized cause of chronic pain after inguinal repair. Arch Surg (in press)Google Scholar
  6. 6.
    Starling JR, Harms BA (1994) Ilioinguinal, iliohypogastric, and genitofemoral neuralgia. In: Bendavid R (ed) prostheses and abdominal wall hernia. RG Landes Co, Austin, Texas, pp 351–356Google Scholar
  7. 7.
    Amid PK (2002) A 1-stage surgical treatment for postherniorrhaphy neuropathic pain. Triple neurectomy and proximal end implantation without mobilization of the cord. Arch Surg 137:100–104CrossRefPubMedGoogle Scholar
  8. 8.
    Heise CP, Starling JR (1998) Mesh inguinodynia: a new clinical syndrome after inguinal herniorrhaphy? J Am Coll Surg 187:514–518CrossRefPubMedGoogle Scholar
  9. 9.
    Cunningham J, Temple WJ, Mitchell P, Nixon JA, Preshaw RM, Hagen NA (1996) Cooperative hernia study. Pain in the postrepair patient. Ann Surg 224:598–602CrossRefPubMedGoogle Scholar
  10. 10.
    The EU Hernia Trialists Collaboration (2002) Repair of groin hernia with synthetic mesh: Meta-analysis of randomized controlled trials. Ann Surg 235:322–332CrossRefPubMedGoogle Scholar
  11. 11.
    Bay-Nielsen M, Perkins FM, Kehlet H (2001) Pain and functional impairment 1 year after inguinal herniorrhaphy: A nationwide questionnaire study. Ann Surg 233:1–7CrossRefPubMedGoogle Scholar
  12. 12.
    Vrijland WW, van Den Tol MP, Luijendijk RW et al. (2002) Randomized clinical trial of non-mesh versus mesh repair of primary inguinal hernia. Br J Surg 89:293–297CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  1. 1.Lichtenstein Hernia InstituteLos AngelesUSA
  2. 2.Department of SurgeryHarbor-UCLA Medical CenterLos AngelesUSA
  3. 3.Department of SurgeryCedars-Sinai Medical CenterLos AngelesUSA

Personalised recommendations