Tailored neurectomy for treatment of postherniorrhaphy inguinal neuralgia

Groin hernia repair occasionally leads to severe chronic pain associated with entrapped or damaged nerves. Conservative treatment is often unsuccessful. Selective neurectomy may be effective, but long-term results are scarce. The authors assessed the long-term efficacy of surgical neurectomy for chronic, postherniorrhaphy groin neuralgia.

A registry of patients with postherniorrhaphy groin pain treated by neurectomy was analyzed. Patients received a questionnaire evaluating the current pain intensity, overall treatment results, and effects on sexual intercourse-related pain. The risk factors for failure and presence of a learning curve were investigated.

Fifty-four patients underwent a neurectomy over a 5-year time period, 49 of whom responded to the questionnaire (response rate, 91%). After a median follow-up period of 1.5 years, 52% claimed to be pain free or almost pain free (good to excellent), 24% reported some relief but still felt pain at a regular basis (moderate), and 24% did not benefit (poor or worse). Sexual intercourse-related pain responded favorably to neurectomy in two thirds of patients. There seemed to be a steep learning curve, and poor treatment results depended on previously received pain regimens (P = .021).

A selective operative neurectomy for postherniorrhaphy groin neuralgia provides good long-term pain relief in most patients. Hernia surgeons should feel responsible for this iatrogenic complication and should consider incorporating selective neurectomy in their surgical armamentarium.