Surgical experience of laparoscopic retroperitoneal triple neurectomy for a patient with chronic neuropathic inguinodynia. (2017)

• Record Type: Journal Article
• Authors: Narita, Masato; Jikihara, Shunpei; Hata, Hiroaki; Matsusue, Ryo; Yamaguchi, Takashi; Otani, Tetsushi; Ikai, Iwao
• Is Part Of: International journal of surgery case reports. Volume 40(2017)
• Page Start: 80
• Page End: 84
• Publication Date: 2017
• Subjects: Inguinal hernia repair -- Chronic pain -- Ilioinguinal nerve -- Treatment -- Surgery -- Herniorrhaphy; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; Surgery; Electronic journals; Periodicals; 617.005
• DOI: 10.1016/j.ijscr.2017.09.012
• Languages: English
• ISSNs: 2210-2612

Abstract

Highlights: Most patients experiencing neuropathic pain following inguinal repair obtain pain relief by means of medical treatments; however, the condition evolves into a chronic refractory state and becomes a disabling disease in a portion of patients. We report a successful case of surgical treatment by means of laparoscopic retroperitoneal triple neurectomy for chronic refractory neuropathic pain after inguinal hernia repair. Laparoscopic retroperitoneal triple neurectomy is a challenging procedure but is useful for refractory neuropathic pain. A thorough understanding of the neuroanatomy of inguinal nerves is necessary to perform safe and effective surgery. Diagnosis of neuropathic pain by thorough preoperative assessment is also vital for the success of this procedure because it is not effective for other types of pain. Abstract: Background: Neuropathic inguinodynia following inguinal hernia repair sometimes becomes a disabling disease. We report a case of successful surgical treatment of chronic refractory neuropathic pain after inguinal hernia by laparoscopic retroperitoneal triple neurectomy. Case presentation: A seventy-year-old male who underwent right-side inguinal hernia repair using the Lichtenstein method revisited our hospital with inguinodynia 16 months after surgery. After a thorough assessment, the patient was diagnosed with neuropathic pain based on the following: 1) dermatomal mapping suggested ilioinguinal and iliohypogastric nerve problems, 2) pain was evoked by specific movement, 3) the site of maximum pain was slightly changed at every physical examination, and 4) no evidence of recurrence or meshoma was observed on MRI. Conservative therapies were ineffective. Surgical intervention using laparoscopic retroperitoneal triple neurectomy was performed 4 months after treatment initiation. In the lateral recumbent position, a three-port method was used. The ilioinguinal and iliohypogastric nerves and the genital branch of the genitofemoral nerves were identified and resected. Although a residual nerve emerged from L2/3 toward the inguinal region, the nerve remained in situ. Pain assessment 3 h after surgery revealed that pain was decreased but remained. Reoperation involving resection of the residual nerve was performed on the same day. Although another type of mild pain appeared 3 months after surgery, the patient resumed normal life, without any restrictions. Conclusions: Laparoscopic retroperitoneal triple neurectomy is useful for treating refractory neuropathic pain. The diagnosis of neuropathic pain via thorough preoperative assessment is vital for procedure success because the procedure would not be effective for other types of pain.