Preperitoneal transabdominal laparoscopic neurectomy as treatment of inguinodynia. Personal experience and details of the surgical technique

Abstract

Introduction: Chronic inguinal pain is currently the most feared complication after a hernioplasty. Its impact on the patient's quality of life and its health impact are of the first magnitude. The aim of this study is to present our experience with laparoscopic neurectomy. Method: Prospective and consecutive study, performed in a specialized Abdominal Wall Unit, which included 21 patients operated on for chronic pain refractory to conservative treatment for more than 1 year using a laparoscopic approach. The primary endpoint was the pain control quantified by a questionnaire and the need for analgesics. The secondary endpoint was perioperative morbidity. Results: The mean surgical time was 55 (SD 18) minutes. There were no intraoperative complications. All patients had histological confirmation of neurectomy. Anatomical variations were found in 13 patients (61.9 %), with the ilioinguinal / iliohypogastric nerve being the most common. In one patient, the femorocutaneous nerve (4.7 %) was mistakenly sectioned. It was reoperated 6 months later to complete ilioinguinal nerve neurectomy. Medications for neuropathic pain were continued by 5 patients. Pain was completely eliminated in 15 patients (71.4 %). Conclusions: The adequate treatment of patients with chronic neural pain requires the existence of Multidisciplinary Units Specialized in Abdominal Wall. Preperitoneal transabdominal laparoscopic neurectomy is a safe and effective approach, provided it is performed in very well selected patients. Adequate anatomical-surgical training is essential to avoid inadvertent injuries during the training acquisition process.