Unmasked neuropathic groin pain: risk of reoperation

Identifying factors associated with unmasked neuropathic groin pain after peripheral nerve surgery may clarify its pathophysiology and risks, reduce reoperations, and improve patient outcomes and satisfaction.

We retrospectively evaluated adults who underwent neurectomy between June 2006 and January 2025 for groin pain localized to the iliohypogastric nerve (IHN), ilioinguinal nerve (IIN), genital branch of the genitofemoral nerve (GBGFN), or lateral femoral nerve (LFN). Patients were stratified by whether they underwent reoperation for unmasked neuropathic pain in a new anatomical distribution. Outcomes were assessed using Numeric Rating Scale (NRS) and functional scores. Multivariate logistic regression identified independent predictors of reoperation. Minimum follow-up was 6 months.

Of 273 patients, 255 (93.4%) patients did not require reoperations and 18 (6.5%) required reoperations for unmasked pain (median time to reoperation: 133 days). Among patients with unmasked pain, the most common initial pain distribution was that of the IIN (88.8%), whereas the most common unmasked distribution was that of the GBGFN (72.2%). GBGFN resection and muscle resection/transposition were associated with lower odds of reoperation. Lower BMI; pain, tingling, and/or burning in the scrotum, testicles, or labia; higher initial NRS scores for the "lowest" pain; and sharp pain were associated with greater odds of reoperation.

Neuropathic pain was unmasked at new locations following 6.5% of neurectomy procedures. Surgeons should reassess patients preoperatively for genital GBGFN pathology and consider including this nerve in operative plans when findings are subtle, potentially preventing reoperation. These data may also inform consent discussions.