Retroperitoneal endoscopic neurectomy for nerve entrapment after hernia repair

Background Entrapment neuralgia after open and laparoscopic hernia repair occurs in about 1-2 per cent of patients. If the pain persists accurate identification of the nerve involved and surgical treatment is an option. Entrapment neuralgia of the genital branch of the genitofemoral nerve and ilioinguinal nerve occurs, but damage to the femoral branch of the genitofemoral nerve, the lateral femoral cutaneous nerve and the femoral nerve is also described. This paper reports an endoscopic technique for neurectomy. Methods A balloon catheter is inserted bluntly into the lower retroperitoneum and insufflated to create a work space. Neurectomy is performed under endoscopic guidance. Results Three men with a mean age of 39 years were treated using this technique. A neurectomy of the genitofemoral nerve was performed in all three and in one neurectomy of the ilioinguinal nerve was also done. The mean operating time was 70 min and all the patients were completely pain-free after surgery. All patients were discharged within the first 2 days after operation and there were no complications. Conclusion This retroperitoneal endoscopic technique is proposed as a new surgical approach for treating entrapment neuralgia. It is simple and effective at relieving symptoms.