long term efficacy of triple neurectomy

[saro]

quote allj:

I have been living with significant groin pain since having mesh removal after an inguinal hernia repair and a neurectomy. I am considering a triple neurectomy but can’t find anything on long term outcomes. Nor have I found anyone who had this procedure who can attest to the longer term outcome. If anyone can help me out with this it would be much appreciated.
Thank you
Alan

I put other topics and, as Dr. Towfigh has pointed out, they are rather verses from your question, so I apologize. about the pain, besides the excellent dr Brown, there is also another renowned specialist that I quote you, by chance https://www.baltimoreperipheralnervepain.com/bio/baltimore-nerve-pain-specialist-eric-h-williams-md-pain-relief-pain-reduction-burning-paid-n.cfm?utm_source=Email&utm_medium=Email&utm_campaign=Williams%20Bio

[Good intentions]

https://healthcare.utah.edu/fad/mddetail.php?physicianID=u0235667&name=daniel-j-vargo

[Good intentions]

quote inguinalpete:

A bunghole named Dr. Daniel vargo of university of utah did a triple nerve removal on me during a sports hernia operation after saying none would be removed. The only Ill effect has been some skin numbness. The progrip mesh is the problem for me.

The insults won’t help to find a solution, although the urge is understood. Objective analysis is the way to go, I think.

Mesh is not typically used for sports hernia repair. I don’t think that neurectomy is either. It looks like you might have had a misdiagnosis from the beginning, and your “sports hernia” was actually an inguinal hernia. Mesh has no place in athletic pubalgia repair according to surgeons who understand the problem.

[USER=”2580″]DrBrown[/USER] [USER=”935″]drtowfigh[/USER]

Still not right to perform a prophylactic triple neurectomy. Seems like mal practice.

Good luck. Start a topic specific to your problem and people might have some advice.

[inguinalpete]

A bunghole named Dr. Daniel vargo of university of utah did a triple nerve removal on me during a sports hernia operation after saying none would be removed. The only Ill effect has been some skin numbness. The progrip mesh is the problem for me.

[DrBrown]

Dear Saro.
I agree with Dr Towfigh.
The nerves should be preserved and handled very gently.
Regards
Bill Brown MD

[allj]

Thanks. Any idea where this is done regularly? I called Beth Israel Pain clinic in Boston – they said they do it but not regularly.

[Victim73]

Pulsed RF ablation of nerves are Done by pain doctors. They send low heat pulsed impulses to the nerves with the help of needdles . İt is less invasive. Unfortunatelly it is not permanent. They disturb the pain signals. Please write pulsed RF ablation on the Google.

[saro]

I’m also very worried about nerves, but I talked to some patients at the follow-up visit after a month of surgery: I thought I knew about complaints, but after neurectomy they didn’t complain about particular problems, and the pain lasted a few days and the hypoesthesia seems to be lasted a week.
Only one still had
non-annoying hypoesthesia after a month I haven’t met anyone
with a biological prosthesis (animal dermis) so far, but I know it spreads but
I can’t find any reports

[allj]

Thanks NFG12 and Jgens and others. I just wish I didn’t have the mesh replaced with alloderm, an absorbable mesh that is no longer used for hernia repair and has limited strength.

[jgens99218]

Alan…. What NFG12 said is spot on correct. Once mesh is in you and things go wrong then numerous unpredictable results are likely if mesh is removed or nerves are cut. It is not what we want to hear but it is true. Good Luck JG

[allj]

Dr. Towfigh – I really appreciate all the advice and warnings from you and others who have posted. The nerve cutting was the surgeon’s idea. After reading the posts I’m not going to agree to this. Part of my concern is that the mesh that was removed was replaced with alloderm. With all the negativity about this absorbable, I’m worried thinking I should have a stronger mesh implanted posteriorly (original is anterior) before I’m much older (I’m 73). I was told by other surgeons that I have a “watch and see” hernia. Is this too risky? Is my thinking flawed? I don’t know what to do. Thanks again

[Unknown Member]

Sorry to hear what you are going through. The more surgeries you have escpecially in the same spot alters that area and with each surgery more and more scar tissue forms which causes pain itself. The 2 nerves that are always damaged usaully are the ilioinguinal and the genital branch of the GF nerve. A neuroma may have formed over time from having the ilioinguinal nerve cut, they usually try to bury it away from the scared area. Once we get done what most surgeons tell us is a walk in the park and mesh is the gold standard when problems arise they are horrible and life changing. A lot of the top supposed hernia surgeons/mesh removal surgeons that names pop up on here all the time have cut nerves and performed triple neurectomys as a first step without even removing the mesh but as time has went on I think they would rather now remove the mesh and deal with nerves at the same time or a later date then as a first step. Ive also heard as you as with the more surgeries a patient has that say if a surgeon just removed the mesh and the person is still in pain when they go back in they might not even be able to see much of anything including nerves because of how much scar tissue has formed and ive heard that with just getting mesh removal alone that when scar tissue does start to form it can grow over the nerves and even the spermatic cord which will cause pain. I know if a patient is getting mesh removed for pain if a nerve is caught in it that it is better to take the nerve than to perform neurolysis which is just releasing it just so they don’t take the chance of it being already damaged or scar tissue forming back over it and entrapping it. You may have developed a neuroma from the single neurectomy of the ilioinguinal nerve, sometimes they try to grow back also. Most of us or should I say all of us will have pain for forever just from the damage the mesh has already done while inside us sadly enough even after having the mesh removed or any nerves cut. I hope you can find some answers and relief soon!

[drtowfigh]

[USER=”2821″]allj[/USER] its hard to judge what you need via the information in this forum alone. But, in general, try not to get nerves cut if there are other options and if you do need any cut, they should be cut as anteriorly as possible.

[DrBrown]

The nerves should be preserved during hernia repair. The nerves need to be identified and treated with care.
Neurolysis will traumatize and should not be done.
Bill Brown MD

[allj]

No – what is it and have you had it done?

[Victim73]

Have You consider pulsed radio frequency????

[allj]

Sounds scary. I have random nerve pain and was thinking the alloderm is absorbed and not very strong. I also get pain in the hernia area more frequently after exercises like riding a bike than I did a few years ago. Do you think it folly to have another implant posterior (the first was anterior) and reject the nerve cutting or is the whole thing folly? Also if I put off having a neurectomy can this be done anteriorly or can it only be done posteriorly? Thanks

[Good intentions]

quote allj:

New surgeon is going to put in a heart skin muscle from a pig covered with a plastic mesh. He wants to cut the inguinal higher and thinks the sensations that are being picked up are from the iliohypo nerve and wants to cut that up. If I understood him correctly he said the new mesh and skin will make it difficult if not impossible to do the ilihypo later if that is causing a problem.

Good luck Alan. You are far in to the realm of experimentation. As has been written on the site by real surgeons, the various nerves are not distinct and separate. There is “cross talk” and interconnectivity.

Why is he planning to implant more mesh, for a pain problem? Do you have another hernia? I would be worried. Consciously or subconsciously, older people are seen as not worth as much time and effort as younger people. There was an article very recently in one of the major publications, the NY Times I think, about it. Your surgeon is planning to use a new and unproven (in humans) material and cut nerves that he is unsure of, creating a situation that will, by his own words, be permanent and unfixable. I don’t see any good coming from his plan. Lots of guessing and hoping.

Read mamadunlop’s stories and plan carefully.

https://www.herniatalk.com/5197-6-hernia-surgeries-6-months-post-op-new-pain

[allj]

I am had an anterior mesh removal and alloderm replacement and inguinal neurectormy 12 yrs agi. New surgeon is going to put in a heart skin muscle from a pig covered with a plastic mesh. He wants to cut the inguinal higher and thinks the sensations that are being picked up are from the iliohypo nerve and wants to cut that up. If I understood him correctly he said the new mesh and skin will make it difficult if not impossible to do the ilihypo later if that is causing a problem. I’m 73 and can no longer do many things I used to even just a few yrs ago without more pain so was hoping to just get a posterior repair and not worry about herniation in the future as I age.

[Good intentions]

quote allj:

Dr. Towfigh – The surgeon wants to re-cut the inguinal nerve higher up and the iliohypo at the same time. He said if it isn’t done during the lap procedure it will be buried in the mesh and difficult to impossible to do later.

Hello Alan. Did you mean scar tissue when you said mesh? Your first post said you’ve already had a mesh removal.

I would get a second and third opinion. If your first surgeon gets offended then they probably don’t really have your best interests in mind.

I think that cutting nerves is in the same category as amputation. Just cut the offending body part off and the problem is gone. But new ones will appear. It’s a simplistic approach to a complex problem.