Long-term outcome following ilioinguinal neurectomy for chronic pain

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Object

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.

Methods

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.

Results

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.

Conclusions

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.

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Figures

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    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.

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