Treatment of obturator neuralgia with laparoscopic neurolysis.
OBJECTIVE
Obturator neuralgia is a cause of pelvic and perineal pain that is rarely suggested, probably because it is poorly understood. We report the results of a pilot study of laparoscopic treatment for obturator neuralgia.


METHODS
Seven patients (8 nerves) with obturator neuralgia were treated at our department. The etiology was idiopathic in 3 cases and iatrogenic following inguinal hernia surgery in 3 and TVT(R) repair in 2. The diagnosis was based on allodynic pain of the anterior and internal surface of the thigh, which was associated with limping with a sidestepping gait. It was confirmed by an anesthetic block under computerized tomography monitoring using a posterior approach.


RESULTS
Treatment consisted of transperitoneal laparoscopic neurolysis with dissection of the nerve and section of the scarring fibrosis or prosthetic mesh in contact with it. In idiopathic cases nerve release was performed by sectioning the internal obturator muscle and the obturator membrane, causing compression and making it possible to widen the obturator foramen. At a mean followup of 16 months the rate of an at least 50% improvement in pain was 87.5% (7 of 8 cases), including complete disappearance of pain in 50% (4 of 8).


CONCLUSIONS
Minimally invasive treatment with laparoscopic truncular release of obturator neuralgia yielded encouraging and good results.
Rigaud
Jérôme
J
Urology Department, Hôtel-Dieu University Hospital Centre, Nantes, France.
Labat
Jean-Jacques
JJ
Riant
Thibault
T
Hamel
Olivier
O
Bouchot
Olivier
O
Robert
Roger
R
D000328:Adult; D015331:Cohort Studies; D003714:Denervation / Q000379:methods*; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009437:Neuralgia / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D009776:Obturator Nerve; D010147:Pain Measurement; D010865:Pilot Projects; D020127:Recovery of Function; D013997:Time Factors; D016896:Treatment Outcome