long term efficacy of triple neurectomy

[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. I wanted to be conservative and do a repair now and worry about the nerve issues later and only do it if I can’t tolerate the pain. If necessary, can the nerves successfully be done later? Thanks for your help.
Alan

[rc009]

Why are there so few to report on the success rate of neurectomy? Of the thousands done I only see a few scattered reports. Do the successful ones never comment?

[Jnomesh]

Search these threads. I believe dr. Towfigg said it is better to cut the nerves lower this a anterior approach is better for neurectomy and that the nerves have more motor function the closer to the spine they are. I’d clarify before I’d proceed

[allj]

I found a reputable and skilled surgeon who is going to do an lap procedure on me. I already have an ilioinguinal neurectomy. He wants to cut the nerve higher and at the same time cut the iliohypo nerve. I am so reluctant to cut another nerve but he said this picks up a lot of the innervation when the ilioing is cut. Any thoughts on having the procedure done with the suggested neurectomies? Is there any benefit having a posterior vs anterior

neurectomy

?

I read that I could also develop abdominal wall laxity. Is this painful?

Thanks again! Alan

[saro]

quote Momof4:

I will weigh in on this subject since I have had a triple neurectomy, performed laparoscopically, near to the spine. I didn’t have any problems with the procedure itself. It was performed by a top hernia specialist in 2014. The area of numbness has not been bothersome and is still significant, 5 years later. In an appt with Dr. Chen, 2 years later, for chronic groin pain and mesh reaction, he noted that I wasn’t as numb as was expected after triple neurectomy. Some nerves regenerate over time, so some of my sensation had returned. Before my surgery I asked if there were any effects besides sensory and was old No. This hasn’t proved to be the case. I think as time has gone on and more triple neurectomies performed, the thinking on that has changed and physicians now realize there are some other effects. I am having some muscle wall laxity that is contributing to my long list of problems since the neurectomy, problems with recurrent hernias and mesh reactions that aren’t related to the triple neurectomy.

Also, I have been a patient at The Dellon Nerve Institute In Baltimore, MD. Dr. Eric Williams is a top nerve specialist and would be a great person to see next. He specializes in all things related to nerves and is very familiar with nerve problems after hernia repair and mesh removal. He performs ultrasound guided, diagnostic nerve blocks in office, if possible. If not, he can send you to Johns Hopkins for further, more extensive diagnostic testing. He also offers surgery for this problem, when appropriate. We are holding off on surgery for my nerve problem, for now, due to the complexity of my condition and number of previous abdominal/groin surgeries and multiple recurrent hernias. He referred me to Johns Hopkins to pursue Cryo-ablation. He is still willing to help me if the less invasive treatments are unsuccessful.

I hope this helps. Best wishes on finding the optimal treatment for your problem. If you would like to ask more specific questions, feel free to message me privately on this forum.

ok, i sent you private message.

While I was in the hospital waiting room, I talked to some patients on a follow-up visit about a month after the surgery.

I must say that they looked good, although they had undergone surgery, including neurectomy of two nerves.

They only reported a tolerable loss of sensitivity (as you write in this post).

Therefore I am pleased for their success, but I remain skeptical about the procedure, which I would prefer to avoid for the reasons listed by Dr. Brown and, according to your experience, this sensation is irreversible, and other problems will be added

[Momof4]

I will weigh in on this subject since I have had a triple neurectomy, performed laparoscopically, near to the spine. I didn’t have any problems with the procedure itself. It was performed by a top hernia specialist in 2014. The area of numbness has not been bothersome and is still significant, 5 years later. In an appt with Dr. Chen, 2 years later, for chronic groin pain and mesh reaction, he noted that I wasn’t as numb as was expected after triple neurectomy. Some nerves regenerate over time, so some of my sensation had returned. Before my surgery I asked if there were any effects besides sensory and was old No. This hasn’t proved to be the case. I think as time has gone on and more triple neurectomies performed, the thinking on that has changed and physicians now realize there are some other effects. I am having some muscle wall laxity that is contributing to my long list of problems since the neurectomy, problems with recurrent hernias and mesh reactions that aren’t related to the triple neurectomy.

Also, I have been a patient at The Dellon Nerve Institute In Baltimore, MD. Dr. Eric Williams is a top nerve specialist and would be a great person to see next. He specializes in all things related to nerves and is very familiar with nerve problems after hernia repair and mesh removal. He performs ultrasound guided, diagnostic nerve blocks in office, if possible. If not, he can send you to Johns Hopkins for further, more extensive diagnostic testing. He also offers surgery for this problem, when appropriate. We are holding off on surgery for my nerve problem, for now, due to the complexity of my condition and number of previous abdominal/groin surgeries and multiple recurrent hernias. He referred me to Johns Hopkins to pursue Cryo-ablation. He is still willing to help me if the less invasive treatments are unsuccessful.

I hope this helps. Best wishes on finding the optimal treatment for your problem. If you would like to ask more specific questions, feel free to message me privately on this forum.

[saro]

thank You Dr Towfigh for your illustrious opinion. I follow the debate on the nerves, like an ignorant reader, and it is very difficult to navigate between the different methods. I hope I don’t make big mistakes if I expose what appears to me (I am a patient). The anterior abdominal access meets the three important nerves; on this the guidelines leave the choice to the surgeon: if the nerve is in the operating field, if an injury is feared, the nerve can be cut ( Better a hypoesthesia (or paresthesia) than a pain) . On the other hand, the alternatives to anterior access are the Laparoscopic and the posterior access: but I know that both require prostheses. You can save your nerves but wear a mesh. In America, porcine prosthesis is also spreading; frankly it is not easy to understand if it is a “natural” alternative or if it takes risks like any prosthesis.

[drtowfigh]

I don’t agree with that

[saro]

I read that prophylactic neurolysis would be preferable to prophylactic surgical blocking of the nerves, because it interrupts the sensoriality, injuring a nerve, but saving its basal lamina, where the nerve will grow back. While the surgical block also cuts the basal lamina.

[drtowfigh]

This paper discusses neurectomy for chronic pain. That is a different situation from elective or prophylactic neurectomy. Also, it was done by neurosurgeons. That’s a different situation than treating chronic pain by a hernia expert. Post inguinal hernia repair chronic pain is often more complex than a single neuroma.

[allj]

Dr. Towfigh –

I’m not sure my question

about the long term efficacy of triple neurectomies was

answered. I only found one study regarding long term outcomes of triple neurectomy. It reported that “

The mean follow-up duration was 34.78 months. Return of pain was reported by 13 (68%) of 19 patients. Using a verbal numerical rating scale (0-10), pain was completely relieved in 27.8%, better in 38.9%, no better in 16.7%, and worse in 16.7% of patients.”

Is this due to the way the procedure was done or is this what I can expect?
Thanks Alan

Long-term outcome following ilioinguinal neurectomy for chronic pain. – PubMed – NCBI
https://www.ncbi.nlm.nih.gov
J Neurosurg. 2010 Apr;112(4):784-9. doi: 10.3171/2009.8.JNS09533.

[drtowfigh]

I am not aware of preventive neurolysis. That doesn’t make any sense. Only neurectomy. Some do it for inguinal hernias. Studies don’t support any particular method. Many of us experts recommend not disturbing the nerves during primary (first time) inguinal hernia repair. In mesh removal, neurectomy may be necessary.

[saro]

quote DrBrown:

To treat pain after mesh hernia repair it is important to try to determine the exact cause of the pain. Check for a recurrent hernia. A nerve block will help determine if the nerves are involved. The mesh can also be injected with local anesthesia to help determine if the mesh is the source of the trouble. Other structures that can be also be injected such as the inguinal ligament, the spermatic cord, etc. Once the etiology of the pain is identified the appropriate plans can be made.
Mesh pain is a difficult problem and is the source of my gray hair.
Regards.
Bill Brown MD

I came across an accredited site where a surgeon questioned colleagues about the opportunity to practice preventive neurectomy in elective surgery to avoid possible chronic pain. Fortunately, almost all the colleagues from all parts of the world have especially supported the need to preserve nerves. Even when a nerve was wrongly damaged during the elective procedure, it could be caustic. Also for dont risk to damage the nervs in the surgery which occurs in the case of incidental resection or stress, some doctors instead practice a preventive neurolysis …what do you think about preventive neurolysis, is it a safe practice to preserve nerves?

[allj]

Thank you DrBrown. This info really helps. All I have to do now is find someone who will follow this plan.
Alan

[DrBrown]

To treat pain after mesh hernia repair it is important to try to determine the exact cause of the pain. Check for a recurrent hernia. A nerve block will help determine if the nerves are involved. The mesh can also be injected with local anesthesia to help determine if the mesh is the source of the trouble. Other structures that can be also be injected such as the inguinal ligament, the spermatic cord, etc. Once the etiology of the pain is identified the appropriate plans can be made.
Mesh pain is a difficult problem and is the source of my gray hair.
Regards.
Bill Brown MD

[allj]

“One wrong turn just one wrong turn”. Thanks to everyone.
I will definitely contact the Dellon institute.

Dr. Towfigh your good advice is always appreciated.

I assumed the weakness I have is because I had an alloderm replacement and the mesh removed. I am currently talking to a skilled surgeon about doing a lap repair (since the other repairs were done openly) in hopes of strengthening the area. Does this make sense? (my thinking is that I’m 73 and if I get much older and the alloderm/collegen doesn’t hold I’ll be too old to operate on)

Good intentions – I had mesh removal and a single neurectomy of the inguinal nerve ~

12 yrs ago

. I have also kept active – mostly bike, exercising and hiking but when I’m not active for a short time I’m in slow agony – death by a 1000 cuts. Activity seemed to keep the nerve activity down and the area feels stronger but more recently exercising has aggravated the groin hernia repair area causing significant innervation elsewhere in the area and weakness. Even standing, I had little strength and walking reverberated pain in the area. The surgeon prescribed a steroid pack and nsaids and after 3 weeks I am starting to exercise again. He also suggested getting a triple neurectomy with Dr. Chen. After reading the helpful comments I realize this isn’t a fix-all and may be misery. I’m leery of doing it.
Thank you all – so glad and thankful there are people like you
Alan

[Victim73]

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 received mesh removal and triple neuroctomy. I am in a worse situation. Dont do it.

[drtowfigh]

Make sure your surgeon is skilled and aware of risks associated with neurectomies. Prior to committing to them, nerve blocks and even nerve stimulator may be a good choice.

The nerves have motor function the closer they are to the spine. More distally, they become mostly sensory, so cutting them in the front (anterior, open) has less abdominal weakness issues.

The sexual dysfunction described by some is not directly related to the neurectomy. It’s often related to chronic pain and use of opioids.

[Good intentions]

I think that there are injections that you can try beforehand that will tell if a neurectomy will help. [USER=”2580″]DrBrown[/USER] is familiar with them.

Can you give more detail on your activities since mesh removal? I found that, while healing from my own mesh removal, certain pain was resolved by being more active. Running or hiking, even though it seemed counterintuitive. Rest did not help at all. There seemed to be dead zones that needed help to get fluid moving, to promote healing. Dr. Bendavid’s work on a potential reason for mesh-induced pain was illuminating. Nerves need good blood supply to be healthy.

[Jnomesh]

Worth contacting as he specializes in nerve issues and groin pain.