Options after open triple neurectomy + meshoma removal

[Joy]

Three and a half years ago an ultrasound showed two left inguinal hernias that were thought to be causing recurrent abdominal pain and I underwent “routine” hernia surgery. The pain was almost immediate, excruciating. I was lucky enough to have doctors who helped me figure out the problem, and had a triple neurectomy 18 months ago from a highly reputable surgeon who was able to extricate the PHS mesh that was entwined in nerves and blood vessels. The II and IH nerves were implanted in muscle, but I had new pain immediately after the surgery all along my hip bone, front to back, and it persisted for some time. I also still have pain in the inguinal area that varies from an ache to a burn. I am nowhere near as active as I was before the first botched hernia surgery. My pain levels are lower than before the neurectomy; that was intolerable pain. But I am still in considerable pain, all the time; my pain improvement seemed to plateau at 3.5 months after the neurectomy. I gave myself until 18 months to wait to see, and now I need to make a decision: do I consider more surgery to explore what might be going on or just learn to deal with it? A doctor out on the east coast who also has a hernia forum (who didn’t do my surgery) suggested I get input from other surgeons about a high neurectomy, higher up closer to the spine. His opinion is that it’s very risky and that only a very few doctors can perform it successfully (Drs. Chen and Towfigh). Any thoughts on this “high triple neurectomy” or any other options for those of us still in pain after triple neurecotmy + meshoma removal. For patients like me, what do you think is going on – might we have scar tissue building up, or maybe the hip bone pain suggests that the nerve(s) weren’t successfully implanted and some neuromas have developed, or something else? What should I do? By the way, I am considering starting a support group for folks who have chronic pain even after a triple neurectomy. There are arguably many of us, and perhaps we can share what works for us. If Dr. Towfigh allows this I can share this link here, but I will wait for her approval. Thanks for any advice for those of us in the unfortunate group for whom this surgery wasn’t able to completely remove the pain.

[drtowfigh]

Options after open triple neurectomy + meshoma removal

It is unfortunately a known risk of neurectomy, that is neuroma formation or nerve-type pain after the transection.
If that is indeed the cause of chronic pain, then re-excision is an option. Other lesser options also exist, such as nerve stimulation and cryoablation/alcohol ablation.
The re-excision technique depends on the other needs you may have and may be performed in open or laparoscopic manner. There are risks with the laparoscopic technique including abdominal wall laxity and denervation.

[jgens99218]

Options after open triple neurectomy + meshoma removal

Dr. Towfigh

It is sometimes unclear to me when answers are provided regarding “Neurectomy”.

For the sake of this question I will assume “Neurectomy” means the transection (completely cut or separation) of a nerve that is then buried in muscle tissue. This is done to prevent Neuroma?

Joy states that she had a triple Neurectomy but was still in pain 18 months after the procedure. You state that neuroma is a known risk after neurectomy? I thought the buried nerve prevents this neuroma formation?

If Joy had nerves that were cut and properly imbedded into muscle tissue it would seem she should no longer experience pain (at least pain caused by nerves). It would seem that another nerve operation “higher up closer to the Spine” would be unnecessary?

Any clarification would be greatly appreciated.

JG

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