Neurectomy with 2nd surgery

Hernia Discussion Forums Hernia Discussion Neurectomy with 2nd surgery

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    • #10701
      MikeL
      Member

      Question to specialists. Why is neurectomy not done “by default”/”highly recommended” when corrective procedure is performed? There are enough cases with repeatative issues on the operated site, especially groin hernias and groin muscle tears. At the same time I have not found any evidence in literature that neurectomy is “highly recommended” at re-do surgery. I have done such repair after re-injury of my operated groin and this solved the chronic pain issues. Is it so easy to evaluate nerves during surgery whether they are damaged or not and then make decision rather than do this operation as “preventive” step? I realize that laparoscopic approach will not be applicable in such case and may potentially be affected as 1st choice by many surgeons. What is your opinion?

    • #14368
      drtowfigh
      Keymaster

      Neurectomy with 2nd surgery

      If revisional surgery involves approaching the groin hernia in the same manner as the original surgery AND mesh needs to be removed, then risk of need for neurectomy is real. The reason is because nerve injury may occur as a result of peeling off the mesh, as the mesh is placed over the nerves. In normal state, if the nerves are not disturbed, most patients have no problems having mesh on the nerve, as the mesh and nerve on in their own planes, millimeters from each other but not eroded into each other. As part of the mesh removal process, a few millimeters of adjacent adherent tissue may be removed with the mesh and so that may (or may not) result in nerve injury, as the nerve or nerve part may be part of that tissue that is removed. Our eyes alone cannot detect any microscopic injury to the nerve. Thus, the safest position taken by some surgeons is the cut the sensory nerve that may be damaged as part of the mesh removal portion of the operation.

      Hope it helps.

    • #14369
      drtowfigh
      Keymaster

      Neurectomy with 2nd surgery

      If revisional surgery involves approaching the groin hernia in the same manner as the original surgery AND mesh needs to be removed, then risk of need for neurectomy is real. The reason is because nerve injury may occur as a result of peeling off the mesh, as the mesh is placed over the nerves. In normal state, if the nerves are not disturbed, most patients have no problems having mesh on the nerve, as the mesh and nerve on in their own planes, millimeters from each other but not eroded into each other. As part of the mesh removal process, a few millimeters of adjacent adherent tissue may be removed with the mesh and so that may (or may not) result in nerve injury, as the nerve or nerve part may be part of that tissue that is removed. Our eyes alone cannot detect any microscopic injury to the nerve. Thus, the safest position taken by some surgeons is the cut the sensory nerve that may be damaged as part of the mesh removal portion of the operation.

      Hope it helps.

    • #14371
      Mesh
      Member

      Neurectomy with 2nd surgery

      They are not sensory nerves. They serve motor function. I bodybuilded for 10 years and can control and flex every muscle and now I am paralyzed and incapable of innervating my groin muscles which need to be innervated to walk and hold your stomach up.

    • #14377
      MikeL
      Member

      Neurectomy with 2nd surgery

      First of all, I am deeply sorry to hear that such shocking result took place with neurectomy. I should probably be more specific with my question. Namely, I was referring to ilioinguinal and iliohypogastric nerves going through the groin area affected by torn tissues and mesh. Literature reports about success of such type of procedure when applicable. For example:
      https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1570605/
      http://www.giornalechirurgia.it/index.php?PAGE=articolo_dett&id_article=5296&ID_ISSUE=613
      I also believe that there is a debate that has started among specialists about mesh vs pure tissue repair. Mesh was primarily targeting high hernia recurrence rate occurred with non-mesh technique. However, nerves are seems to be down side of the open repair using mesh. I do realize the lap repair was developed to minimize problems with nerves. However, I am sure that lap approach has its own potential drawbacks. I also believe that any general surgeon must have all techniques in his possession to address any groin issue (including pure tissue repair). I think that general perception of hernia procedure as some sort of commodotized medical procedure among many people is a big problem and possibly it is worth of establishing general groin surgeon specialty that would include pelvic region and adductors. I am not a medical doctor or professional and my opinion is based on my personal very limited observation of the groin medical problems.

    • #14378
      jgens99218
      Member

      Neurectomy with 2nd surgery

      Dr. Towfigh

      If mesh is removed and a part or section of a nerve is removed along with the mesh what is likely to happen with the damaged or cut nerve if the nerve end is not buried into muscle/tissue (neurectomy)? In other words if the damaged or cut nerve is just left hanging there. When I say cut I also mean portions of the nerve are missing.

      Can you also confirm the definition of neurectomy? I understand it to be when a severed nerve (proximal end) is buried into muscle/tissue, is this correct? I do not know if there is medical terminology for when a nerve is severed and is left untreated from there?

      Thanks, JG

    • #14475
      jgens99218
      Member

      Neurectomy with 2nd surgery

      Dr. Towfigh

      Are you able to respond to my question regarding what happens to a nerve that is cut during the mesh removal process, see my original question below? Since I still suffer from pain 19 months after mesh removal I want to know if the cut remains of my nerve/nerves were just left hanging there what is likely to happen to them if a re-connection never happens? Will it always form a neuroma? if not does the nerve just heal over at its cut end? Wouldn’t either condition result in permanent pain?

      Thanks

      JG

    • #14476
      drtowfigh
      Keymaster

      Neurectomy with 2nd surgery

      A cut nerve can go in one of three ways:
      1. Heal and result in numbness or dysfunction based on whatever function that nerve is supposed to have
      2. Have scar tissue grow into the cut nerve end and result in a neuroma. This may cause pain or hyperfunction /hyperstimulation of the nerve.
      3. Regrowth of the nerve with reconnection and recomminication with nearby nerve end or other nerves. The results of this is unpredictable.

      In short, the goal of most elective neurectomies is plan #1. It is also the most common outcome.

      Pain is not always neuropathic. Ie, pain may be due to other things besides a cut nerve.

      • #27896
        Anonymous
        Inactive

        so Genjtal is cut..cremaster not working..testicle and scrotum no longer supported…..ilioinguinal and iliohypogastric nerves were also cut..its like I have no strength in my groin…its numb but its also weak like its not contracting or supporting my body….

    • #14488
      jgens99218
      Member

      Neurectomy with 2nd surgery

      Thank You Dr. Towfigh

      My issues display symptoms neuropathic in nature, burning,tingling, and unusual hard to describe pains that I have never experienced before. The pain is erratic and I actually have some days that are not that bad and other days that are not very nice.. I thought after 19 months any Non-Neuropathic pain would have resolved or healed? Not sure how much longer to do nothing about this?

      I am not sure where to go from here because given the nature of nerve injuries there are not many options. If I have developed neuromas then what would be the best course of action? My understanding is neurectomy is a last resort.

      Thanks

    • #14520
      drtowfigh
      Keymaster

      Neurectomy with 2nd surgery

      nerve-related pain is complex. you can start with a pain management specialist or a hernia specialist who has experience with nerve-related pain. just tolerating the pain without getting treatment can actually be worse, as some studies show that that can train the brain to live in a chronic pain state.

    • #12377
      jgens99218
      Member

      Neurectomy with 2nd surgery

      Doctor Towfigh

      I am in Massachusetts do you recommend any doctors near me that are well versed in pain management after mesh removal surgery? I have met with Doctor Earle once but I am not sure if nerve related issues are his forte. Certainly doctor Earle is a skilled hernia surgeon.

      Also what would you recommend as an approach to treatment? I am afraid that medications, physical therapy. Nerve block Injections and various other modalities result in temporary relief and are not a long term solution. Half the battle is knowing what is actually causing my issues. I believe it is nerve related but cannot determine if it is neuroma, nerve entrapment, or what. This is further complicated by the fact that proper neurectomy can result in aberrant nerve sprouting and possibly not provide permanent relief.

      I do know that I do not have a hernia recurrence. I am puzzled to think I may still have non nerve related issues this late in my recovery?

      No win situation.

      JG

    • #27897
      Alephy
      Participant

      Is the mesh close to the nerves also when placed laparoscopically?

    • #27901
      Droppain
      Participant

      I can empathize with Julian. I had the same result after a neurectomy. Different surgeon though. I had the ilioinguinal and iliohypogastric cut in one surgery and the genitofemoral cut in another. I was told, like Julian, they were sensory nerves. I was not told that there is a MOTOR branch of the genitofemoral nerve. Either the surgeon didn’t know or he felt it was inconsequential. In any event I lost the cremasteric and dartos muscle reflexes. These control the testicle and scrotal muscles so basically my testicle just hangs and is exquisitely painful. Nothing sensible can be done to repair it. Believe me I’ve investigated it. I’m also impotent as a result. So my recommendation is always think long and hard before agreeing to mesh removal and consider all of the downsides. I wish I had.

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