surgeons who practice preventive neurectomy

[DrBrown]

[USER=”2012″]saro[/USER]
A few patients have a bulky cremasteric muscle that can make the repair of the inguinal floor difficult, in those patient I sometimes remove the cremastic muscle. If the cremasteric muscle is excise the testicle does not retract in response to cold and during intercourse.
If there is a lipoma of the spermatic cord or an indirect hernia, the cremasteric muscle can be split to get access to those structures. The cremasteric does not have to be excised.
I do not routinely cut the nerves. Once cut there is no way to be sure that it will grow back.
Regards
Bill Brown MD

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[saro]

quote DrBrown:

Dear Saro.
Preventive neurectomy only started after mesh was introduced. Sometimes after hernia repair the nerve can become scarred to the mesh resulting in pain.
There are three major nerves in the inguinal area. The iliohypogastric nerve, the ilioinguinal nerve, and the genital nerve. The iliohypogastric nerve provides sensation to the pubic hair area and the upper part of the scrotum or Mons. The ilioinguinal nerve provides sensation along the inguinal ligament, on the inside of the upper thigh, and on the outside of the scrotum or Mons. The genital nerve provides innervation to the cremasteric muscles and sensation to the testicle or labia majora.

Damage to any of these nerves can cause chronic pain after the surgery. Some surgeons advise routine transection of these nerves to avoid postoperative pain. But cutting the nerves causes the skin to be numb. And if the nerve tries to grow back and a neroma forms, then that can be a source of cause chronic pain. It is best to carefully identify the nerves during the operation. And then take care not to damage the nerves while the hernia is being repaired.

The iliohypogastric nerve can usually be identified running parallel to the inguinal ligament about a centimeter above the level of internal ring and deep to the external oblique aponeurosis. It will emerge through a hole in the external oblique aponeurosis just above the external inguinal ring and continue its journey to the skin.

The ilioinguinal nerve joins the spermatic cord (or round ligament in women) at the internal inguinal ring and then runs along the anterior superior aspect the spermatic cord (or round ligament).

The genital nerve usually joins the spermatic cord (or round ligament) at the internal inguinal ring and then runs along the posterior aspect of the spermatic cord (or the round ligament). Of the three nerves, the course of genital nerve is the most variable. Instead of traveling with the spermatic cord (or round ligament), it can be found near the inguinal ligament or running along the floor of the inguinal canal.
Regards.
Bill Brown MD

excellent dr Brown
sorry if I return to your post which I think is unexceptionable, confirmed by a distinguished colleague who is expert in nerves, who has had the kindness to write to me about it, so I have no reason to doubt. Moreover it is intuitive that the nerves should be preserved, they are there for vital functions. however, many patients are perhaps at the same crossroads as the following. I knew that in Europe there are many good surgeons that the doctor Towfight has also recommended in another post, but not all of them are reachable from any location, even Europe is large. In particular, assuming that the mesh can be avoided, if possible, patients may find themselves at a crossroads: operating from a surgeon who preserves the cremaster muscle or from a surgeon who preserves the nerves. In this case the surgeon declare that the rescued nerves would grow back. The other surgeon that the cut of cremaster muscle is necessary to access the bag and the cord. Don’t you think so, but do you think that this possibility exists that the nerves, if you cut properly, can grow back? and what do you think of disorders after cremastere cutting , are they so unbearable? Thanks for the further reply you will want to give us. I know it doesn’t comfort her, but also me I’ve also had white hair after i had hernia

[mitchtom6]

Thank you Dr. Brown for your thorough response.

[DrBrown]

Dear Saro.
Preventive neurectomy only started after mesh was introduced. Sometimes after hernia repair the nerve can become scarred to the mesh resulting in pain.
There are three major nerves in the inguinal area. The iliohypogastric nerve, the ilioinguinal nerve, and the genital nerve. The iliohypogastric nerve provides sensation to the pubic hair area and the upper part of the scrotum or Mons. The ilioinguinal nerve provides sensation along the inguinal ligament, on the inside of the upper thigh, and on the outside of the scrotum or Mons. The genital nerve provides innervation to the cremasteric muscles and sensation to the testicle or labia majora.

Damage to any of these nerves can cause chronic pain after the surgery. Some surgeons advise routine transection of these nerves to avoid postoperative pain. But cutting the nerves causes the skin to be numb. And if the nerve tries to grow back and a neroma forms, then that can be a source of cause chronic pain. It is best to carefully identify the nerves during the operation. And then take care not to damage the nerves while the hernia is being repaired.

The iliohypogastric nerve can usually be identified running parallel to the inguinal ligament about a centimeter above the level of internal ring and deep to the external oblique aponeurosis. It will emerge through a hole in the external oblique aponeurosis just above the external inguinal ring and continue its journey to the skin.

The ilioinguinal nerve joins the spermatic cord (or round ligament in women) at the internal inguinal ring and then runs along the anterior superior aspect the spermatic cord (or round ligament).

The genital nerve usually joins the spermatic cord (or round ligament) at the internal inguinal ring and then runs along the posterior aspect of the spermatic cord (or the round ligament). Of the three nerves, the course of genital nerve is the most variable. Instead of traveling with the spermatic cord (or round ligament), it can be found near the inguinal ligament or running along the floor of the inguinal canal.
Regards.
Bill Brown MD

[saro]

to avoid permanent nerve damage, which occurs in the case of incidental resection or stress, some doctors instead practice a preventive neurolysis … from what I could understand neurolysis is a practice used especially in the case of irreducible pain, however it is not equivalent to nerve cutting (neurectomy) and differs from nerve block … but of the three practices mentioned, only neurolysis is practiced during a primary intervention in some specialists, but I don’t know how successful …it would be interesting to know the opinion of the doctors of the site on neurolysis, the drtowfigh pls
if they read me, because this subject is of strict competence for the specialist doctors and for anesthesiologists ..

[saro]

https://www.researchgate.net/post/What_should_be_the_current_practice_concerning_nerve_s_management_during_open_inguinal_hernia_repair_preservation_or_neurectomy