Brian P. Jacob, David C. Chen, Bruce Ramshaw, Shirin Towfigh (eds.) - The SAGES Manual of Groin Pain-Springer International Publishing (2016)

25. Laparoscopic Triple Neurectomy
Stephanie A. Kingman , Parviz K. Amid ,
and David C. Chen
Introduction
Inguinal hernia repair, with the use of mesh and tension-free techniques,
has seen significant improvements in outcomes and decreased
recurrence rate. However, postherniorrhaphy chronic pain remains a
considerable complication affecting as many as 63 % of patients after
surgery [ 1 – 3 ]. Such pain interferes with the physical activity, social
interactions, employment, and productivity of 6–8 % of patients after
herniorrhaphy, causing notable burden on the individual and society
[ 2 – 6 ].
In addition to pain from hernia recurrence, inguinodynia can be
caused by factors relating to nociceptive or neuropathic pain [ 7 – 12 ].
Nociceptive pain is induced by tissue injury and inflammation from
forceful tissue handling and retraction or from foreign material such as
meshoma. Neuropathic pain is provoked by direct nerve injury, perineural
scarring, or entrapment injuries by suture, fixating devices, or mesh.
Classically, it presents as inguinodynia with radiation to the scrotum/
femoral triangle, hyperalgesia, allodynia, hyper- or hypoesthesia, and
paresthesias. There is no clear distinction between these two types of
pain, and the diagnosis is often complicated by genetic, psychological,
social, and economic factors [ 2 – 5 , 9 ].
Nonsurgical management, including pharmacologic, interventional,
and behavioral therapies, is successful in many patients. Nonetheless,
operative intervention is necessary in some cases. The most definitive
and effective remedial surgery for refractory neuropathic inguinodynia
is triple neurectomy of the ilioinguinal, iliohypogastric, and genitofemoral
nerves. This technique, described by us in 1995 with further technical
© Springer International Publishing Switzerland 2016
B.P. Jacob et al. (eds.), The SAGES Manual of Groin Pain,
DOI 10.1007/978-3-319-21587-7_25
333