Long-term outcome following ilioinguinal neurectomy for chronic pain

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Ilioinguinal neuralgia is one cause of chronic groin pain following inguinal hernia repair, and it affects ~ 10% of patients. Selective ilioinguinal neurectomy is one proposed treatment option for carefully selected patients. The goal of this study was to determine the long-term outcome of patients who underwent selective ilioinguinal neurectomy for chronic post-hernia pain.


The authors retrospectively reviewed the clinical assessment, surgical treatment, and long-term outcome in 26 patients with ilioinguinal neuralgia who underwent selective ilioinguinal neurectomy performed by the senior author (K.J.B.) at Oregon Health & Science University between 1998 and 2008. Data were collected from patient charts and a follow-up telephone questionnaire.


Twenty-six patients (14 men and 12 women) had a clinical diagnosis of ilioinguinal neuralgia based on a history of radiating neuropathic groin, medial thigh, and genitalia pain. One patient had bilateral disease (therefore there were 27 surgical cases). A selective nerve block was performed in 21 (81%) of 26 patients and was positive in 20 (77%) of the 26. In all but 2 patients, pain onset followed abdominal surgery (for hernia repair in 18 patients), and was immediate in 16 (67%) of 24 patients. The mean patient age was 48.7 years, and the mean duration of pain prior to neurosurgical consultation was 3.9 years. Surgery was performed after induction of local or general anesthesia in 17 and 10 cases, respectively. The ilioinguinal nerve was identified in 25 cases, and the genitofemoral nerve in 2, either entrapped in mesh, scar, or with obvious neuroma (22 of 27 cases). The identified nerve was doubly ligated, cut, and buried in muscle at its most proximal point. At the 2-week follow-up evaluations, 14 (74%) of 19 patients noted definite pain improvement.

Nineteen (73%) of the 26 patients were contacted by telephone and agreed to participate in completing long-term follow-up questionnaires. The mean follow-up duration was 34.78 months. Return of pain was reported by 13 (68%) of 19 patients. Using a verbal numerical rating scale (0–10), pain was completely relieved in 27.8%, better in 38.9%, no better in 16.7%, and worse in 16.7% of patients.


Ilioinguinal neurectomy is an effective and appropriate treatment for selected patients with iatrogenic ilioinguinal neuralgia following abdominal surgery. Although a high proportion of patients reported some long-term recurrence of pain, complete or partial pain relief was achieved in 66.7% of the patients observed.

Article Information

Address correspondence to: Kim J. Burchiel, M.D., Department of Neurological Surgery, Mail Code: CH8N, Oregon Health & Science University, 3303 SW Bond Avenue, Portland, Oregon 97239. email: burchiek@ohsu.edu.

Please include this information when citing this paper: published online September 25, 2009; DOI: 10.3171/2009.8.JNS09533.

© AANS, except where prohibited by US copyright law.



  • View in gallery

    Photographs showing exploration of left inguinal hernia wound. A: Lateral extension toward anterior superior iliac spine. B: Full opening of wound with exposure of lateral mesh wall and ilioinguinal nerve exiting the transversus muscle and surrounded by scar going under mesh. C: The distal ilioinguinal nerve has been cut and the proximal end is about to be doubly ligated and cut as it exits the transversus muscle.


  • 1

    Aasvang EKehlet H: Chronic postoperative pain: the case of inguinal herniorrhaphy. Br J Anaesth 95:69762005

  • 2

    Aasvang EKehlet H: Surgical management of chronic pain after inguinal hernia repair. Br J Surg 92:7958012005

  • 3

    Aasvang EKBay-Nielsen MKehlet H: Pain and functional impairment 6 years after inguinal herniorrhaphy. Hernia 10:3163212006

  • 4

    Alfieri SRotondi FDi Miceli DDi Giorgio ARidolfini MPFumagalli U: [Chronic pain after inguinal hernia mesh repair: possible role of surgical manipulation of the inguinal nerves. A prospective multicentre study of 973 cases.]. Chir Ital 58:23312006. (Italian)

  • 5

    Amid PK: A 1-stage surgical treatment for postherniorrhaphy neuropathic pain: triple neurectomy and proximal end implantation without mobilization of the cord. Arch Surg 137:1001042002

  • 6

    Amid PK: Causes, prevention, and surgical treatment of postherniorrhaphy neuropathic inguinodynia: triple neurectomy with proximal end implantation. Hernia 8:3433492004

  • 7

    Bay-Nielsen MNilsson ENordin PKehlet H: Chronic pain after open mesh and sutured repair of indirect inguinal hernia in young males. Br J Surg 91:137213762004

  • 8

    Bay-Nielsen MPerkins FMKehlet H: Pain and functional impairment 1 year after inguinal herniorrhaphy: a nationwide questionnaire study. Ann Surg 233:172001

  • 9

    Benito-Leon JPicardo AGarrido ACuberes R: Gabapentin therapy for genitofemoral and ilioinguinal neuralgia. J Neurol 248:9079082001

  • 10

    Callesen TBech KKehlet H: Prospective study of chronic pain after groin hernia repair. Br J Surg 86:152815311999

  • 11

    Courtney CADuffy KSerpell MGO'Dwyer PJ: Outcome of patients with severe chronic pain following repair of groin hernia. Br J Surg 89:131013142002

  • 12

    Grant AMScott NWO'Dwyer PJ: Five-year follow-up of a randomized trial to assess pain and numbness after laparoscopic or open repair of groin hernia. Br J Surg 91:157015742004

  • 13

    Heise CPStarling JR: Mesh inguinodynia: a new clinical syndrome after inguinal herniorrhaphy?. J Am Coll Surg 187:5145181998

  • 14

    Hindmarsh ACCheong ELewis MPRhodes M: Attendance at a pain clinic with severe chronic pain after open and laparoscopic inguinal hernia repairs. Br J Surg 90:115211542003

  • 15

    Kim DHMurovic JATiel RLKline DG: Surgical management of 33 ilioinguinal and iliohypogastric neuralgias at Louisiana State University Health Sciences Center. Neurosurgery 56:101310202005

  • 16

    Mui WLNg CSFung TMCheung FKWong CMMa TH: Prophylactic ilioinguinal neurectomy in open inguinal hernia repair: a double-blind randomized controlled trial. Ann Surg 244:27332006

  • 17

    O'Dwyer PJAlani AMcConnachie A: Groin hernia repair: postherniorrhaphy pain. World J Surg 29:106210652005

  • 18

    Picchio MPalimento DAttanasio UMatarazzo PFBambini CCaliendo A: Randomized controlled trial of preservation or elective division of ilioinguinal nerve on open inguinal hernia repair with polypropylene mesh. Arch Surg 139:7557592004

  • 19

    Poobalan ASBruce JSmith WCKing PMKrukowski ZHChambers WA: A review of chronic pain after inguinal herniorrhaphy. Clin J Pain 19:48542003

  • 20

    Rab MEbmer JDellon AL: Anatomic variability of the ilioinguinal and genitofemoral nerve: implications for the treatment of groin pain. Plast Reconstr Surg 108:161816232001

  • 21

    Ravichandran DKalambe BGPain JA: Pilot randomized controlled study of preservation or division of ilioinguinal nerve in open mesh repair of inguinal hernia. Br J Surg 87:116611672000

  • 22

    Rozen DAhn J: Pulsed radiofrequency for the treatment of ilioinguinal neuralgia after inguinal herniorrhaphy. Mt Sinai J Med 73:7167182006

  • 23

    Starling JRHarms BA: Diagnosis and treatment of genitofemoral and ilioinguinal neuralgia. World J Surg 13:5865911989




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