Surgical Treatment of Abdominal Wall Neuromas

Abstract

Background: Neuromas are an under-recognized contributor to chronic abdominal pain. Other than after mesh inguinal hernia repair, surgical management of painful abdominal wall neuromas has not been well established in the literature. Methods: All patients who underwent surgical treatment for painful abdominal wall neuromas by the senior author at Northwestern Memorial Hospital were reviewed. Patients were treated with neuroma excision and allograft nerve reconstruction and/or with targeted muscle reinnervation (TMR). Follow-up pain surveys were issued to assess pain levels, activities of daily living, and pain medication usage. Results: Twenty patients met inclusion criteria. Eighteen (90%) patients reported improvement in neuropathic pain postoperatively. Two (10%) patients had TMR following failed nerve allograft reconstruction, which led to complete pain resolution. Twenty-seven nerves were treated surgically, the majority of which were abdominal intercostal ( 13), followed by ilioinguinal (10), genitofemoral (3), and iliohypogastric (1). Nerve allograft reconstruction was used alone for 18 procedures, in combination with TMR for 2, and TMR was used alone in 8. In all cases of TMR, the freshened nerve ending after neuroma excision was coapted to a motor nerve of the internal oblique. The mean length of follow-up was 18.9 months (SD ±14.5). Conclusions: This retrospective review demonstrated that 90% (18) of the patients had significant improvement in abdominal neuroma pain postoperatively. These results may help guide providers toward effective management of abdominal wall neuropathic pain.

Mesh abdominoplasty for rectus diastasis in women and men

“…While short-term pain typically requires a hospitalization, long-term pain has not been an issue for these patients, though one patient required physical therapy at 6 months. If chronic pain were to develop, treatment would involve intercostal nerve excision and allograft reconstruction [19]. This has not been necessary to date.…”

Symptomatic neuroma development following en bloc resection of skeletal and soft tissue tumors: A retrospective analysis of 331 cases

“…Neuroma-related pain may limit activities of daily living in this population, delaying a return to baseline functioning or employment. 9,19 In prior studies, Park et al reported a 25% prevalence of persistent neuropathic pain following sarcoma surgery with attributed factors of multiple resections and pelvic tumor location; however, neuromas and major nerve injuries were excluded from this cohort. 20 Fiore et al reported a 41% prevalence of neuropathic pain following multivisceral resection for retroperitoneal sarcoma.…”

“…3,4 Painful neuromas have also been reported following elective hand surgery, 5,6 cosmetic operations, 7 and various others. [8][9][10][11][12] Factors previously associated with painful neuroma development in these populations include involvement of cutaneous nerves 13 and avulsion injury. 14 Sarcomas are malignancies that arise from mesenchymal tissue and most commonly develop in skin, bone, subcutaneous tissue, and muscle.…”

“…3,4 Painful neuromas have also been reported following elective hand surgery, 5,6 cosmetic operations, 7 and various others. 8–12 Factors previously associated with painful neuroma development in these populations include involvement of cutaneous nerves 13 and avulsion injury. 14…”

The Peripheral Nerve Surgeon’s Role in the Management of Neuropathic Pain

“… 73 The last decade has seen a marked expansion in utilization of TMR and RPNI. TMR has expanded to other surgeries, including breast, 74 abdominal wall, 75 and headache surgery. 76 Likewise, studies have shown RPNI can treat symptomatic neuromas in amputee patients.…”