A 1-stage surgical treatment for postherniorrhaphy neuropathic pain - Triple neurectomy and proximal end implantation without mobilization of the cord

Background: The recommended surgical treatment for chronic neuropathic pain after herniorrhaphy has been a 2-stage operation including: (1) ilioinguinal and iliohypogastric neurectomies through an inguinal approach and (2) genital nerve neurectomy through a flank approach. Hypothesis: A 1-stage surgical procedure resecting all 3 nerves from an anterior approach avoids a second operation through the Bank and successfully treats chronic neuralgia. Setting: A private practice dedicated to abdominal wall hernia surgery in general community hospitals. Patients: Between 1995 and 2001, 49 patients underwent triple neurectomies with proximal end implantation to treat chronic postherniorrhaphy neuralgia. Intervention: Triple neurectomy of the ilioinguinal, iliohypogastric, and genital nerves performed under local anesthesia with implantation of their proximal ends and without mobilization of the spermatic cord. Results: Two patients (4%) reported no improvement. Eighty percent of patients recovered completely, and 16% had transient insignificant pain with no functional impairment. These results are comparable to the results of the 2-stage operation. Conclusions: Simultaneous neurectomy of the ilioinguinal, iliohypogastric, and genital nerves without mobilization of the spermatic cord is an effective 1-stage procedure to treat postherniorrhaphy neuralgia. It is performed under local anesthesia and avoids testicular complications, Proximal end implantation of the nerves prevents adherence of the cut ends to the aponeurotic structure of the groin, which can result in recurrence of the pain.