Endoscopic retroperitoneal neurectomy for chronic pain after groin surgery

Giger, Urs; Wente, Moritz N.; Büchler, M.; Krähenbühl, Stephan; Lerut, Jan; Krähenbühl, L.

doi:10.1002/bjs.6623

Cited by 52 publications

(31 citation statements)

References 25 publications

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“…Giger used an endoscopic retroperitoneal approach in 39 patients with chronic groin pain, describing complete pain relief in 80% of the cases, a transient relief in 16% [14]. The genital branch of the genitofemoral nerve can, according to Giger, not be found through the anterior approach.…”

Section: Discussionmentioning

confidence: 99%

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Transabdominal laparoscopic retroperitoneal neurectomy for chronic pain after inguinal hernia repair and appendicectomy –a matched-pair study

et al. 2017

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BackgroundChronic debilitating pain is a rare but significant cause of postoperative morbidity after inguinal surgery. Such pain is usually of neuropathic origin and frequently caused by intraoperative nerve damage. In this retrospective matched-pair study we analysed results of a minimal-invasive approach to neurectomy on quality of life and pain relief.MethodsFrom March 2010 to January 2012, 9 patients developing chronic neuropathic pain after inguinal hernia repair (8 patients) or open appendicectomy (one patient) were operated using a laparoscopic transabdominal approach in our department. Clinical examinations and specific questionnaires on pain and quality of life (PainDetect, SF-36) were completed 6 months to 3 years after neurectomy. Every patient was matched with one patient without chronic pain.ResultsSeven of nine patients had severe or very severe pain before neurectomy, two had mild pain but refused a conservative treatment. Four patients were free of pain after neurectomy, three described an improved pain status, whereas two did not observe any change in pain. Within a follow-up period of 14,3 months, no deterioration of pain or other complications were observed. Patients who underwent neurectomy had significantly lower quality of life compared to the control group. No postoperative complications were observed.ConclusionsLaparoscopic transabdominal neurectomy represents a possible surgical approach in treating patients with chronic disabling postoperative groin pain requiring surgery. This technique was feasible, safe, and effective in our series to relieve chronic debilitating pain in the majority of our patients with comparable results to other published approaches.

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Section: Discussionmentioning

confidence: 99%

“…Surgery success rates in reducing chronic pain are variable, mainly depending on the patient selection criteria, and have been reported between 30% and 100% [9, 10]. Furthermore, minimal-invasive retroperitoneal approaches have also been described for accessing the groin nerves offering similar success rates [14, 15]. …”

Section: Introductionmentioning

confidence: 99%

Transabdominal laparoscopic retroperitoneal neurectomy for chronic pain after inguinal hernia repair and appendicectomy –a matched-pair study

et al. 2017

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“…The IIN and IHN can be identified within the retroperitoneal space over the quadratus lumborum muscle and the GFN over the psoas muscle proximal to the scarred operative field. Endoscopic retroperitoneal selective neurectomies of the GFN and IIN have been reported 128,129. As with the open experience, laparoscopic retroperitoneal triple neurectomy has higher efficacy rates 120.…”

Section: Surgical Pain Managementmentioning

confidence: 99%

“…Laparoscopic retroperitoneal triple neurectomy may be performed through a transabdominal or extraperitoneal approach 120,128,129. The IIN and IHN can be identified within the retroperitoneal space over the quadratus lumborum muscle and the GFN over the psoas muscle proximal to the scarred operative field.…”

Section: Surgical Pain Managementmentioning

confidence: 99%

Pain control following inguinal herniorrhaphy: current perspectives

Bjurström¹,

Nicol²,

Amid³

et al. 2014

JPR

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Inguinal hernia repair is one of the most common surgeries performed worldwide. With the success of modern hernia repair techniques, recurrence rates have significantly declined, with a lower incidence than the development of chronic postherniorrhaphy inguinal pain (CPIP). The avoidance of CPIP is arguably the most important clinical outcome and has the greatest impact on patient satisfaction, health care utilization, societal cost, and quality of life. The etiology of CPIP is multifactorial, with overlapping neuropathic and nociceptive components contributing to this complex syndrome. Treatment is often challenging, and no definitive treatment algorithm exists. Multidisciplinary management of this complex problem improves outcomes, as treatment must be individualized. Current medical, pharmacologic, interventional, and surgical management strategies are reviewed.

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“…Preoperative mean pain score was 7.7/10, which reduced to 1.3/10 postoperatively. Giger et al [33] included 39 patients with CPSP after hernia repair to evaluate endoscopic retroperitoneal neurectomy. In all cases 4-5 cm resection of the genitofemoral nerve, including the bifurcation, was performed, and when required, the ilioinguinal nerve and iliohypogastric nerves were resected.…”

Section: Neurectomymentioning

confidence: 99%

Intervention techniques for chronic postherniorrhaphy pain

et al. 2011

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Background: Chronic post-surgical pain is the main problem after inguinal hernia repair, frequently mandating treatment. Different treatment modalities are proposed. The aim of this review was to evaluate recent literature on different interventions to treat chronic inguinal pain after inguinal hernia repair and their outcomes.Methods: The Medline database, CINAHL, Embase, and Pubmed, including e-links to related articles, and the clinical trial registry of the Cochrane Collaboration were searched for relevant articles. Studies since 2001 reporting an intervention and their outcome to treat chronic postoperative inguinal pain in adult patients were selected. Study design, length of follow-up, number of included and evaluated patients, definition of chronic pain, description, as well as outcome of the intervention are extracted.Results: A total of 29 studies were included; eleven of them were prospective, the remaining retrospective. One study about pharmacological treatment (n ¼ 2), two studies about peripheral nerve blockage (n ¼ 9), three studies about pulsed radiofrequency (n ¼ 12), four studies about neurostimulation (n ¼ 7), one study about removal of staples or tackers (n ¼ 1), one study about neuroablation (n ¼ 10), and 17 studies about neurectomy (n ¼ 733) were included.Conclusions: This collective review shows the broad spectrum of interventions to treat chronic postoperative inguinal pain. Due to a wide range of pain definitions and outcome measurement a true comparison is difficult.

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Endoscopic retroperitoneal neurectomy for chronic pain after groin surgery

Abstract: ERN for chronic postoperative genitofemoral nerve entrapment neuropathy was successful in the majority of patients selected for the procedure. This minimally invasive approach allows simultaneous neurectomy of genitofemoral and ilioinguinal nerves.

Cited by 52 publications

References 25 publications

Transabdominal laparoscopic retroperitoneal neurectomy for chronic pain after inguinal hernia repair and appendicectomy –a matched-pair study

Transabdominal laparoscopic retroperitoneal neurectomy for chronic pain after inguinal hernia repair and appendicectomy –a matched-pair study

Pain control following inguinal herniorrhaphy: current perspectives

Intervention techniques for chronic postherniorrhaphy pain

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