title: Laparoscopic triple neurectomy for intractable groin pain: technical report of 3 cases.
abstract: BACKGROUND
  Neuropathic groin pain can be a severely debilitating condition. Triple neurectomy of the ilioinguinal, iliohypogastric, and genitofemoral nerves is a viable treatment option.
  
  
  OBJECTIVE
  To present our initial experience with the laparoscopic retroperitoneal approach to triple neurectomy.
  
  
  METHODS
  Three patients (33 to 48 years of age) presented with chronic groin pain of 3 to 7 years' duration. The discomfort manifested in the ilioinguinal, iliohypogastric, and genitofemoral nerve distributions and severely affected their lifestyles, resulting in multiple unsuccessful medical and surgical treatments without symptomatic relief. Because the patients failed other modes of treatment, they underwent a laparoscopic retroperitoneal triple neurectomy.
  
  
  RESULTS
  Three patients underwent a triple neurectomy from November 2006 to May 2009. All patients reported debilitating chronic groin pain and underwent prior treatments ranging from anesthetic blocks to orchiectomy without lasting relief. The first case illustrates the anatomic variation of the genitofemoral nerve and the importance of transecting both branches for adequate symptomatic relief. The remaining cases demonstrate successful transection of all 3 nerves with significant pain relief at 10 months to 3 years of follow-up. No major complications were encountered.
  
  
  CONCLUSIONS
  This technique provides several advantages in the treatment of chronic groin pain. The retroperitoneal approach provides a facile method to reach the nerves in 1 stage and provides a dissection field free of previous scars. As a laparoscopic technique, benefits include small incision sites with small scars, less postoperative pain, and shorter hospitalizations and/or same-day discharges with effective relief of groin pain.
authors.affiliation: Department of Surgery, University of Michigan Health System, Ann Arbor, MI 48109, USA.
authors.forename: Jae W
authors.initials: JW
authors.lastname: Song
authors.forename: J Stuart
authors.initials: JS
authors.lastname: Wolf
authors.forename: John E
authors.initials: JE
authors.lastname: McGillicuddy
authors.forename: Sandeep
authors.initials: S
authors.lastname: Bhangoo
authors.forename: Lynda J-S
authors.initials: LJ
authors.lastname: Yang
mesh_terms: D000328:Adult; D005500:Follow-Up Studies; D006119:Groin; D006552:Hernia, Inguinal / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D010148:Intractable Pain / Q000601:surgery*