title: Tailored neurectomy for treatment of postherniorrhaphy inguinal neuralgia.
abstract: BACKGROUND
  Groin hernia repair occasionally leads to severe chronic pain associated with entrapped or damaged nerves. Conservative treatment is often unsuccessful. Selective neurectomy may be effective, but long-term results are scarce. The authors assessed the long-term efficacy of surgical neurectomy for chronic, postherniorrhaphy groin neuralgia.
  
  
  METHODS
  A registry of patients with postherniorrhaphy groin pain treated by neurectomy was analyzed. Patients received a questionnaire evaluating the current pain intensity, overall treatment results, and effects on sexual intercourse-related pain. The risk factors for failure and presence of a learning curve were investigated.
  
  
  RESULTS
  Fifty-four patients underwent a neurectomy over a 5-year time period, 49 of whom responded to the questionnaire (response rate, 91%). After a median follow-up period of 1.5 years, 52% claimed to be pain free or almost pain free (good to excellent), 24% reported some relief but still felt pain at a regular basis (moderate), and 24% did not benefit (poor or worse). Sexual intercourse-related pain responded favorably to neurectomy in two thirds of patients. There seemed to be a steep learning curve, and poor treatment results depended on previously received pain regimens (P = .021).
  
  
  CONCLUSIONS
  A selective operative neurectomy for postherniorrhaphy groin neuralgia provides good long-term pain relief in most patients. Hernia surgeons should feel responsible for this iatrogenic complication and should consider incorporating selective neurectomy in their surgical armamentarium.
authors.affiliation: Department of General Surgery, Máxima Medical Center, Veldhoven, The Netherlands. loosmaarten@hotmail.com
authors.forename: Maarten J
authors.initials: MJ
authors.lastname: Loos
authors.forename: Marc R
authors.initials: MR
authors.lastname: Scheltinga
authors.forename: Rudi M
authors.initials: RM
authors.lastname: Roumen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006119:Groin / Q000294:innervation*; D006552:Hernia, Inguinal / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009437:Neuralgia / Q000209:etiology / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000379:methods; D010147:Pain Measurement; D011183:Postoperative Complications; D013526:Surgical Mesh; D055815:Young Adult