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Efficacy of retroperitoneal triple neurectomy for refractory neuropathic inguinodynia
Alexandra M Moore1, Martin F Bjurstrom2, Jonathan R Hiatt1
1Department of Surgery, David Geffen School of Medicine, University of California, 1304 15th Street, Suite 102, Santa Monica, CA 90404, USA.
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.
Results:
Mean numerical pain scores were significantly decreased (baseline, 8.6) at all postoperative time points (POD 1, 3.6; P < .001: POD 90, 2.3, P < .001) with durable efficacy from POD 90 to 3 years (P < .001). Quantitative sensory testing showed marked group-level increases of sensory thresholds. Narcotic dependence decreased in 57/62 and was eliminated in 44/62 and activity level improved in 58/62.
Conclusions:
Retroperitoneal triple neurectomy is an effective and durable treatment for refractory neuropathic inguinodynia.
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