Skip to main content

Advertisement

SpringerLink
Log in

Surgical management of postoperative chronic inguinodynia by laparoscopic transabdominal preperitoneal approach

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

The avoidance of postoperative chronic pain is of the foremost importance and has a deep impact on patient satisfaction. The objective of this study is to evaluate the selective transabdominal preperitoneal laparoscopic neurectomy for treatment of refractory inguinodynia.

Methods

Prospective study in a University Hernia Center included 16 consecutive patients with chronic pain. Primary endpoint was pain control (measured by appropriate questionnaire and need of analgesics). Secondary endpoint was surgical morbidity. Follow-up was 2 years (range 12 months–4 years).

Results

The mean operating time was 52 (range 36–68) minutes, and there were no intraoperative complications. All patients had histologic confirmation of neurectomy. Anatomical variation was found in ten patients (62.5 %), being a common trunk ilioinguinal/iliohypogastric nerve the most frequent (nine patients, 56.25 %). One patient developed hypoesthesia in the territory of the femorocutaneous nerve by nerve injury. Reoperation was performed 6 months afterward to complete ilioinguinal nerve neurectomy. Neuropathic pain medications were continued by five patients. Pain was completely eliminated in 11 (68.75 %).

Conclusions

Management of patients with neural groin pain should be done in a multidisciplinary unit. Selective neurectomy by a transabdominal preperitoneal laparoscopic approach is a safe and highly effective option in selected patients for the treatment of refractory postoperative chronic pain. Careful anatomical planning is essential to avoid inadvertent injuries and more suffering to these patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Valvekens E, Nijs Y, Miserez M (2015) Long-term outcome of surgical treatment of chronic postoperative groin pain: a word of caution. Hernia 19(4):587–594

    Article  CAS  PubMed  Google Scholar 

  2. Loos MJ, Roumen RM, Scheltinga MR (2007) Chronic sequelae of common elective groin hernia repair. Hernia 11:169–173

    Article  CAS  PubMed  Google Scholar 

  3. Bjurstrom MF, Nicol AL, Amid PK, Chen DC (2014) Pain control following inguinal herniorrhaphy: current perspectives. J Pain Res 7:277–290

    PubMed  PubMed Central  Google Scholar 

  4. Aasvang E, Kehlet H (2009) The effect of mesh removal and selective neurectomy on persistent postherniotomy pain. Ann Surg 249:327–334

    Article  PubMed  Google Scholar 

  5. Loos MJ, Scheltinga MR, Roumen RM (2008) Surgical management of inguinal neuralgia after a low transverse pfannenstiel incision. Ann Surg 248:880–885

    Article  PubMed  Google Scholar 

  6. Ducic I, West J, Maxted W (2008) Management of chronic postoperative groin pain. Ann Plast Surg 60:294–298

    Article  CAS  PubMed  Google Scholar 

  7. Stulz P, Pfeiffer KM (1982) Peripheral nerve injuries resulting from common surgical procedures in the lower portion of the abdomen. Arch Surg 117(3):324–327

    Article  CAS  PubMed  Google Scholar 

  8. Madura JA, Madura JA II, Copper CM, Worth RM (2005) Inguinal neurectomy for inguinal nerve entrapment: an experience with 100 patients. Am J Surg 189:283–287

    Article  PubMed  Google Scholar 

  9. Lee CH, Dellon AL (2000) Surgical management of groin pain of neural origin. J Am Coll Surg 191:137–142

    Article  CAS  PubMed  Google Scholar 

  10. Kim DH, Murovic JA, Tiel RL, Kline DG (2005) Surgical management of 33 ilioinguinal and iliohypogastric neuralgias at Louisiana State University Health Sciences Center. Neuro-surgery 56:1013–1020

    Google Scholar 

  11. Bouhassira D, Attal N, Alchaar H, Boureau F, Brochet B, Bruxelle J et al (2005) Comparison of pain syndromes associated with nervous or somatic lesions and development of a new neuropathic pain diagnostic questionnaire (DN4). Pain 114:29–36

    Article  PubMed  Google Scholar 

  12. Keller JE, Stefanidis D, Dolce CJ, Iannitti DA, Kercher KW, Heniford BT (2008) Combined open and laparoscopic approach to chronic pain after inguinal hernia repair. Am Surg 74(8):695–701

    PubMed  Google Scholar 

  13. Starling JR, Harms BA, Schroeder ME, Eichmin PL (1987) Diagnosis and treatment of genitofemoral and ilioinguinal entrapment neuralgia. Surgery 102:581–586

    CAS  PubMed  Google Scholar 

  14. Lange JFM, Kaufmann R, Wijsmuller AR, Pierie JPEN, Ploeg RJ, Chen DC et al (2015) An international consensus algorithm for management of chronic postoperative inguinal pain. Hernia 19:33–43

    Article  CAS  PubMed  Google Scholar 

  15. Werner MU (2014) Management of persistent postsurgical inguinal pain. Langenbecks Arch Surg 399:559–569

    Article  PubMed  Google Scholar 

  16. Holloran-Schwartz MB (2014) Surgical evaluation and treatment of the patient with chronic pelvic pain. Obstet Gynecol Clin N Am 41:357–369

    Article  Google Scholar 

  17. Chen DC, Amid PK (2014) Prevention of inguinodynia: the need for continuous refinement and quality improvement in inguinal hernia repair. World J Surg 38:2571–2573

    Article  PubMed  Google Scholar 

  18. Bischoff JM, Enghuus C, Werner MU, Kehlet H (2013) Long-term follow-up alter mesh removal and selective neurectomy for persistent inguinal postherniorrhaphy pain. Hernia 17:339–345

    Article  CAS  PubMed  Google Scholar 

  19. Campanelli G, Bertocchi V, Cavalli M, Bombini G, Biondi A, Tentorio T et al (2013) Surgical treatment of chronic pain alter inguinal hernia repair. Hernia 17:347–353

    Article  CAS  PubMed  Google Scholar 

  20. Krähenbühl L, Strifflerler H, Baer HU, Büchler MW (1997) Retroperitoneal endoscopic neurectomy for nerve entrapment after hernia repair. Br J Surg 84:216–219

    Article  PubMed  Google Scholar 

  21. Muto CM, Pedana N, Scarpelli S, Galardo R, Guida G, Schiavone V (2005) Inguinal neurectomy for nerve entrapment alter open/laparoscopic hernia repair using retroperitoneal endoscopic approach. Surg Endosc 19:974–976

    Article  CAS  PubMed  Google Scholar 

  22. Giger U, Wente MN, Büchler MW, Krähenbühl S, Lerut J, Krähenbühl L (2009) Endoscopic retroperitoneal neurectomy for chronic pain after groin surgery. Br J Surg 96(9):1076–1081

    Article  CAS  PubMed  Google Scholar 

  23. Emeksiz S, Ozden H, Guyen G (2013) Effects of variable courses of inguinal nerves on pain in patients undergoing lichtenstein repair for inguinal hernia: preliminary results. Acta Chir Belg 113:196–202

    Article  CAS  PubMed  Google Scholar 

  24. Klaassen Z, Marshall E, Tubbs RS, Louis RG, Wartmann CT, Loukas M (2011) Anatomy of the ilioinguinal and iliohypogastric nerves with observations of their spinal nerve contributions. Clin Anat 24:454–461

    Article  PubMed  Google Scholar 

  25. Song JW, Wolf JS, McGillicuddy JE, Bhangoo S, Yang LJ (2011) Laparoscopic triple neurectomy for intractable groin pain: technical of 3 cases. Neurosurgery 68:339–346

    PubMed  Google Scholar 

  26. Chen DC, Hiatt JR, Amid PK (2013) Operative management of refractory neuropathic inguinodynia by a laparoscopic retroperitoneal approach. JAMA Surg 148(10):962–967

    Article  PubMed  Google Scholar 

  27. Mahan MA, Kader AK, Brown JM (2014) Robot-assisted triple neurectomy for iatrogenic inguinal pain: a technical note. Acta Neurochir (Wien) 156(1):171–175

    Article  Google Scholar 

  28. Moreno-Egea A, Borras E (2014) Selective ambulatory transabdominal retroperitoneal laparoscopic neurectomy to treat refractory neuropathic groin pain. Rev Hispanoam Hernia 02:67–71

    Article  Google Scholar 

  29. 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 137:100–104

    PubMed  Google Scholar 

Download references

Acknowledgments

The author is grateful for the San Antonio University School of Medicine.

Author information

Authors and Affiliations

  1. Abdominal Wall Unit, La Vega University Hospital, Avda Primo de Rivera 7, 5ºD, 3008, Murcia, Spain

    A. Moreno-Egea

  2. School of Medicine, San Antonio University, Murcia, Spain

    A. Moreno-Egea

Authors
  1. A. Moreno-Egea
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to A. Moreno-Egea.

Ethics declarations

Disclosures

Moreno-Egea has no conflicts of interest or financial ties to disclose.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Moreno-Egea, A. Surgical management of postoperative chronic inguinodynia by laparoscopic transabdominal preperitoneal approach. Surg Endosc 30, 5222–5227 (2016). https://doi.org/10.1007/s00464-016-4867-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-016-4867-0

Keywords

Search

Navigation