Neuropathic pain after neurectomy

[Ben999]

You may remember me, I’ve had two hernia surgeries on the same side and have been doing a lot better since the second one, which was 21 months ago.

The mesh that was implanted in the first surgery caused fibrosis in the n. ilioinguinalis which was neurectomized along with removing the mesh. Since then, I’m pain free while resting and mostly pain free while active. However one thing that still elicits very strong pain is touching the affected area, which is especially distressing considering where it is and that the nerve damage also affects pubic hair. Note that touching also means clothes touching it and to some extent bowel movements (the mesh was a UHS which has a preperitoneal part).

My question is, to doctors and patients who have experience with this, does additional surgery promise improvement? (I would assume neurosurgery, since there is no recurrence and hardly any nociceptive pain).

I’m already waiting for appointments at a pain management clinic and a surgical clinic, only for consultation for now. However, I’m not even sure where to begin exactly. I highly doubt the average, or even above average, hernia surgeon can help me with this and my trust of doctors has become very low in general. If anything, the only thing that makes sense to me is neurosurgery, however none of the websites of neurosurgical clinics I could find in Germany talked about hernias at all. Neuropathic pain in general yes, but never specific to hernias. Pain management seems like the least risky option, but obviously fixing the underlying problem would be ideal.

• This topic was modified 3 months ago by Ben999.

[drtowfigh]

In my experience, most neurosurgeons don’t handle peripheral nerve issues related to hernia surgery. And only some pain management specialists know what to do.

I encourage you to watch the HerniaTalk session I had with Dr Payam Vahedifar, Pain Management specialist who treats many of my patients. The link is here: https://youtu.be/Wxk3LWBrWBg

Basically, if you have neuralgia after a neurectomy, first best choice is repeat nerve block and maybe percutaneous ablation. That is performed by a Pain Management specialist who is experienced in doing so and understands what we do as surgeons. Another surgical neurectomy may also be necessary.

[Ben999]

Thank you Dr. Towfigh. I would definitely prefer a causal treatment to a symptomatic one, but I’m very sceptical about and scared of another surgery. I’ll see what the pain specialist recommends. My GP actually suggested giving me nerve blocks but I would rather have it done by someone with specific experience. Percutaneous ablation also sounds promising. I want to avoid taking pain meds for the rest of my life if possible.

[ajm222]

Hey Ben –

Out of curiosity, did you have any other repair done, or did they just remove the mesh and there was enough scar tissue to hold things?

Thanks

[Ben999]

After the mesh was removed, Dr. Conze decided to do a Shouldice repair since he found it the most appropriate intraooperative decision.

[ajm222]

thank you. i think i initially was confused and thought your mesh was purely posterior and removed robotically. but it sounds like it was a mesh placed openly for the most part originally?

[Ben999]

Yes, an Ethicon UHS, it’s placed openly but with connected posterior and anterior parts

[ajm222]

Got it, that’s helpful. I had a mesh placed robotically and likely to have it removed the same way. The expectation (and hope) is that there is enough scar tissue and no hernia present, and it stays that way with no further repairs needed. Hope you get your nerve issues sorted out. Sounds like your recovery went pretty well otherwise, which personally gives me hope. The nerve stuff is always tricky. I myself don’t seem to have any nerve issues and hoping removal doesn’t introduce any.

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