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

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25. Laparoscopic Triple Neurectomy 339 Fig. 25.7. Relationship between ureter ( X ), iliac artery ( arrow ), and genitofemoral nerve trunk over psoas muscle ( star ). 10 9 8 7 6 * P < .05 vs preop 5 4 * 3 2 * * * (36) (35) (22) * * * 1 0 Pre-Op POD1 POD7 POD30 POD90 POD180 POD360 POD540 Fig. 25.8. Laparoscopic triple neurectomy outcomes: VAS scores. 1.1; p < 0.01). Narcotic dependence was seen to decrease and the activity level of patients increased. All patients reported numbness as anticipated in the distribution of neurectomy. Fourteen (33 %) had transient hypersensitivity consistent with deafferentation, with four patients (9 %) having persistent symptoms greater than 3 months. Seven experienced residual meshoma pain with four of them undergoing a subsequent reoperation for mesh removal. Orchialgia was not improved as expected since paravasal nerves need to be resected to address this problem [ 16 ].
340 S.A. Kingman et al. Discussion With the advances in technique of tension-free inguinal hernia repair, chronic groin pain now surpasses recurrence as the most common longterm postoperative complication. This debilitating condition is a result of nociceptive and neuropathic factors. Given the lack of clear discrimination between the two types of pain, confounded with variables such as excitatory coupling between sympathetic and afferent nociceptive fibers, deafferentation hyperalgesia, pain centralization, and neuroplasticity, as well as patient-related factors, prevention of this complication is of key importance [ 9 , 21 ]. Nociceptive pain can be minimized with gentle handling of tissues and with the use of local anesthetic to decrease the formation of nociceptive molecules. Neuropathic pain can be decreased by meticulous identification and protection of nerves to avoid injury and their direct contact with mesh, which ultimately changes the structure of their fibers. Doing so has been shown to reduce the rate of postherniorrhaphy chronic pain from 5 to 8 % to a fraction of 1 % [ 20 ]. Understanding inguinal and preperitoneal groin neuroanatomy as well as the pathophysiology of inguinal pain helps to guide good operative technique in all methods of inguinal hernia repair. Prevention and avoidance of injury at the time of the original operation are of paramount importance. Numerous operative techniques have been used to address chronic inguinodynia such as revision of the original herniorrhaphy, removal of mesh or fixation device, and selective neurolysis or neurectomy of the ilioinguinal, iliohypogastric, and genitofemoral nerves. These techniques, however, often leave behind injured nerves and do not affect the ultrastructural changes of nerve fibers. Moreover, the considerable variation in anatomy and cross-innervation of the inguinal nerves within the retroperitoneum and inguinal canal can make such procedures unreliable [ 19 , 20 , 22 – 25 ]. The current most effective therapy for the neuropathic component of inguinal pain is triple neurectomy [ 12 – 16 , 22 – 24 ]. In our ongoing series of laparoscopic retroperitoneal triple neurectom y, we have had a 93 % success rate in reducing numeric pain scores and narcotic dependence and improving the quality of life and function in daily activities for patients. Numerically, this demonstrates superior results of the laparoscopic retroperitoneal approach to standard open triple neurectomy (80 %) and extended open triple neurectomy, which includes the resection
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Brian P. Jacob · David C. Chen Bru
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The SAGES Manual of Groin Pain Bria
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Foreword Inguinal hernia repair is
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Contents Part I Primary Groin Pain
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Contents ix 22 Management of Inguin
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Contents xi 45 Value-Based Clinical
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xiv Editors and Contributors Jeffre
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xvi Editors and Contributors David
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xviii Editors and Contributors Greg
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xx Editors and Contributors David S
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1. Introduction to Primary and Seco
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10 I.A. Gawlas and W.J. Peacock Ili
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12 I.A. Gawlas and W.J. Peacock Tra
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14 I.A. Gawlas and W.J. Peacock Var
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3. Complex Regional Pain Syndrome T
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4. Chief Complaint of Groin Pain: H
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4. Chief Complaint of Groin Pain…
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42 C. Ma and A. Ramaswamy inguinal
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44 C. Ma and A. Ramaswamy Categoriz
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46 C. Ma and A. Ramaswamy with no s
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48 C. Ma and A. Ramaswamy 26. Aasva
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50 I.M. Daoud and K. Dunn Other per
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52 I.M. Daoud and K. Dunn low herni
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54 I.M. Daoud and K. Dunn In the po
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56 I.M. Daoud and K. Dunn with a he
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58 I.M. Daoud and K. Dunn 13. O’C
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60 G.J. Mancini Occult Hernia Backg
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62 G.J. Mancini Magnetic resonance
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64 G.J. Mancini rocking motion can
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66 G.J. Mancini Unique to the adduc
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68 G.J. Mancini two nerve injuries
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70 G.J. Mancini abdominis has a rep
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72 G.J. Mancini 5. Light D, Ratnasi
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74 J.C. Campbell and G.D. Paiement
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9. Groin Pain Etiology: Spine and B
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10. Groin Pain Etiology: Spermatic
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Table 10.2. European Association of
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138 M. Hibner and C. Coyne Piriform
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140 M. Hibner and C. Coyne Fig. 11.
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142 M. Hibner and C. Coyne Table 11
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144 M. Hibner and C. Coyne present
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146 M. Hibner and C. Coyne Table 11
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148 M. Hibner and C. Coyne Once the
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150 M. Hibner and C. Coyne 3. Hibne
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12. Chronic Pelvic Pain in Women M.
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12. Chronic Pelvic Pain in Women 15
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174 J.M. Miller et al. Knowing the
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176 J.M. Miller et al. Fig. 13.2. A
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182 J.M. Miller et al. Fig. 13.9. C
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184 J.M. Miller et al. Fig. 13.14.
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192 J.M. Miller et al. Cardiac Cath
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194 B.J. Dunkin Noxious peripheral
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196 B.J. Dunkin Table 14.1. Summary
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198 B.J. Dunkin Rectus abdominis Ex
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200 B.J. Dunkin COX-1 COX-2 Celecpx
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202 B.J. Dunkin Table 14.2. Common
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204 B.J. Dunkin Possible Preoperati
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206 B.J. Dunkin Postoperative Pain
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208 B.J. Dunkin Summary Understandi
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15. Chronic Groin Pain Following An
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222 E.L. Felix not seem to alter th
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224 E.L. Felix nerves from the surg
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226 E.L. Felix Fig. 16.2. Lateral f
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228 E.L. Felix It has been establis
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230 E.L. Felix 18. Pollak R, Nyhus
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17. The Orthopedic Perspective on G
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246 J.F.M. Lange Jr. examination an
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248 J.F.M. Lange Jr. and remedial s
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250 J.F.M. Lange Jr. Best available
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252 J.F.M. Lange Jr. Neuropathic pa
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254 J.F.M. Lange Jr. This algorithm
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19. Radiologic Evaluation for Posto
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19 Radiologic Evaluation for Postop
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268 A. Malhotra extended variant of
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270 A. Malhotra steroid injections,
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272 A. Malhotra located just below
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274 A. Malhotra Nociceptive Acute N
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276 A. Malhotra 20. Rozen D, Parvez
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278 R. Álvarez intentionally or in
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Fig. 21.1. Material: A ballpoint pe
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Fig. 21.5. Dermatome mapping compat
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Fig. 21.9. Dermatome mapping compat
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29. Prevention of Pain: Optimizing
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29. Prevention of Pain: Optimizing
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30. Prophylactic Neurectomy Versus
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Table 31.1. Selective neurectomy wi
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408 W.M.J. Reinpold and A.D. Schroe
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32. Chronic Groin Pain: Mesh or No
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Part IV Case Reports and Patients
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430 S. Towfigh were irregular and s
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432 S. Towfigh in addressing her sy
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434 S. Towfigh Conclusion We have y
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436 K.W. Kercher Physical Examinati
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438 K.W. Kercher Fig. 34.4. Left ad
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440 K.W. Kercher Fig. 34.5. After d
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442 K.W. Kercher the posterior wall
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444 K.W. Kercher Table 34.2. Surgic
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35. Chronic Post-inguinal Herniorrh
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35 Chronic Post-inguinal Herniorrha
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35 Chronic Post-inguinal Herniorrha
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36. Sports Hernia with Adductor Ten
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464 C.G. DuCoin and G.R. Jacobsen P
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466 C.G. DuCoin and G.R. Jacobsen O
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468 J.A. Blatnik and A.S. Prabhu a
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470 J.A. Blatnik and A.S. Prabhu Fi
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472 J.A. Blatnik and A.S. Prabhu ma
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474 S. Towfigh Physical Exam The pa
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476 S. Towfigh The patient’s loca
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478 S. Towfigh Fig. 39.2. Diagram o
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480 S. Towfigh periphery. He is 2+
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482 S. Towfigh References 1. Matthi
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484 N.A. Al-Enazi and B.P. Jacob
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486 N.A. Al-Enazi and B.P. Jacob Fi
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488 N.A. Al-Enazi and B.P. Jacob pu
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42. Patient with Chronic Pelvic Pai
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42. Patient with Chronic Pelvic Pai
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43. Thoracolumbar Syndrome James A.
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43. Thoracolumbar Syndrome 497 The
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43. Thoracolumbar Syndrome 499 Groi
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44. Patient with Referred Hip Pain
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44. Patient with Referred Hip Pain
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45. Value-Based Clinical Quality Im
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46. Patient Care Manager Perspectiv
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47. Workers’ Compensation: An Occ
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532 Index Athletic pubalgia (cont.)
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534 Index Chronic post-herniorrhaph
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536 Index Groin pain (cont.) magnet
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538 Index Ilioinguinal nerve (IIN)
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540 Index Local anesthetics (cont.)
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542 Index Peripheral nerve entrapme
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544 Index S Sacroiliac (SI) joint d
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546 Index Transperineal pudendal ne
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Brian P. Jacob, David C. Chen, Bruce Ramshaw, Shirin Towfigh (eds.) - The SAGES Manual of Groin Pain-Springer International Publishing (2016)

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