Surgical management of postoperative chronic inguinodynia by laparoscopic transabdominal preperitoneal approach

• Published in: Surgical endoscopy Vol. 30; no. 12; pp. 5222 - 5227
• Main Author: Moreno-Egea, A.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.12.2016; Springer Nature B.V
• Subjects: Abdomen; Abdominal Surgery; Adult; Chronic pain; Comorbidity; Female; Gastroenterology; Gynecology; Hepatology; Hernia, Inguinal - surgery; Hernias; Herniorrhaphy - adverse effects; Humans; Inguinal Canal - innervation; Laparoscopy; Male; Medicine; Medicine & Public Health; Middle Aged; Nerve Block; Neuralgia - surgery; Pain, Postoperative - surgery; Patient Satisfaction; Pelvic Pain - surgery; Proctology; Prospective Studies; Questionnaires; Surgery; Surveys and Questionnaires; Tomography; Treatment Outcome; Spain; Hernioplasty; Neurectomy; Laparoscopy; Inguinal pain
• ISSN: 0930-2794; 1432-2218
• DOI: 10.1007/s00464-016-4867-0

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.