Neurectomy – a recent analysis

Hernia Discussion Forums Hernia Discussion Neurectomy – a recent analysis

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    • #33528
      Good intentions
      Participant

      Here is is an elaborate paper trying to show that a specific method of neurectomy is effective at reducing chronic pain from inguinal hernia repair. Unfortunately, they could not draw a firm conclusion.

      It has some interesting parts and references. Overall, it looks like an attempt to show that laparoscopic (“minimally invasive”)neurectomy has some sort of benefit. They could not show that.

      “Is pain control for chronic neuropathic pain after inguinal hernia repair using endoscopic retroperitoneal neurectomy effective? A meta-analysis of 142 patients from 1995 to 2022”

      https://link.springer.com/article/10.1007/s00423-022-02748-6

      “Introduction
      Chronic pain, defined as pain that lasts for three to 6 months and frequently fluctuates, is a recognized complication in patients after groin hernia repair [1]. In the literature, it has been documented that 0.5–37% of patients experience chronic pain after surgical groin hernia repair [2,3,4,5,6,7].”

      Conclusion
      Persistent neuropathic pain is a common complication of surgical hernia repair. However, it is often debilitating as it permanently affects the patient’s physical abilities and mental health. As a result, several techniques have been developed to relieve the symptoms of postoperative inguinal neuropathic pain. We conducted a meta-analysis of five studies on the minimally invasive endoscopic retroperitoneal method for ilioinguinal, iliohypogastric and genitofemoral nerve triple neurectomy. Our analysis showed that endoscopic retroperitoneal neurectomy can be an effective treatment option for postoperative neuropathic pain relief following surgical hernia repair. Considering the small number of patients in this study, data interpretation with regard to efficacy can only be limited. Although there is limited reported experience with this technique, it may provide a clinical benefit to the patient. Further prospective data and long-term follow-up of the triple neurectomy procedure will be needed to confirm these outcomes.”

    • #33551
      PeterC
      Participant

      I cannot take these studies seriously. There’s a guy on here that had a bilateral triple neurectomy and his life was literally ruined. That 1 person should be where the practice ends. Its like they are desperately trying to find something that will match their own bias to justify cutting people’s nerves.

      Cutting nerves is not treatment its a band-aid solution and a lazy one. The nerves are signaling pain because something isn’t right and is flaring them up. The real effort should be going into finding the cause of the nerve flaring up, not removing the signal (nerve) that something is wrong. I’m not saying its easy but that’s where the efforts should be. I use the car analogy all the time but its the same thing. If your “check engine” light goes up on your car you don’t remove the check engine light and then keep driving. You do a deep analysis of why the check engine light is on until you find the issue.

    • #33554
      Watchful
      Participant

      PeterC,

      Sometimes the nerve itself is injured by the surgery, caught in stitches, the mesh, or scar tissue, etc. This can result in chronic pain. In such cases, a nurectomy can be the right treatment.

      • #33571
        PeterC
        Participant

        @gohaiga Absolutely I agree there are cases where its called for. I’m mainly referring to neurectomy as part of the initial procedure for patients which I think is never justified and is absurd. The fact that they started incorporating neurectomies as a standard in certain procedures to “diminish post-op pain” is a big red flag. It feels like they came up with a lousy solution instead of taking a hard look at themselves as to why they were getting patients with nerve pain after their first surgery.

        Additionally all pain in the body is nerve pain. Just because you have pain it doesn’t mean the nerve is damaged. Again they don’t seem to care to differentiate. The patient has pain – they are unable or unwilling to properly investigate and just decide to cut off the nerve. This would be fine if those nerves didn’t have motor functions but they do and on top of that the patient still has whatever injury/tear/issue caused the nerve to get irritated in the first place.

        I’ll give you an example. I was in a facebook group and someone said that their husband had groin pain near the rectus insertion and most likely had injured himself in the form of an athletic pubalgia where there is a tear of the rectus insertion to the pubic bone whether it is micro-tearing that is not visible on imaging or a partial/complete tear. Shortly after he developed intermittent pain near that site & his bladder causing him to go urinate more frequently and pain when urinating. The doctors said “the pain/irritation is coming from your pudendal nerve” which is true. The nerve was being irritated but it didn’t necessarily mean the nerve was injured. The nerve can be producing symptoms without injury and need for removal here. 80% of doctors would have advised something along the lines of removing the nerve because they only look at the symptom and how to stop it.

        The thing is there is a very clear cause & effect here. Instead he got his rectus reattached to the pubic bone (which is where his injury had occurred), balance through his core & pelvic floor was restored and the nerve irritation stopped and never manifested again.

        This is just one example where he was lucky enough that he did not listen to lazy doctors immediately jumping to extremes and instead got the injury addressed and once balanced was restored the symptoms stopped.

        • This reply was modified 1 day, 21 hours ago by PeterC.
      • #33575
        Watchful
        Participant

        I agree, but the paper linked by Good Intentions was about chronic neuropathic pain after inguinal hernia surgery, and neurectomy can be a valid treatment for that.

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