title: Use of the LION procedure on the sensitive branches of the lumbar plexus for the treatment of intractable postherniorrhaphy neuropathic inguinodynia.
abstract: OBJECTIVE
  To report on the use of the laparoscopic implantation of neuroprosthesis (LION) procedure on the sensitive branches of the lumbar plexus for the treatment of refractory postherniorrhaphy neuropathic inguinodynia.
  
  
  METHODS
  Laparoscopic exposure and implantation of an electrode to the different nerves is undertaken by the transumbilical transperitoneal approach. The genitofemoral nerve is identified on the anterior surface of the psoas major muscle, the ilioinguinal, iliohypogastric, and of the lateral femoral cutaneous nerves on the anterior surface of the quadratus lumborum muscle behind the kidney and colon. A quadripolar electrode is placed laparoscopically in direct contact with the injured nerve(s).
  
  
  RESULTS
  All patients included in this series had reported failure of all previous treatments. Twenty-three consecutive patients were included in this series. Success, defined as visual analog scale (VAS) reduction >50%, was obtained in 19 patients. To date (mean follow-up 28.61 months [± 16.2; min. 6 months to max. 68 months]), 11 patients report a reduction of the mean VAS of more than 80% and eight report a reduction of between 50 and 80%; the mean VAS score could be reduced, so far, from 8.1 (± 8.1; range 6-10) preoperatively to 3.1 (± 2.8; range 0-5) postoperatively (P < 0.001).
  
  
  CONCLUSIONS
  The presented technique of laparoscopic implantation permits a selective implantation and neuromodulation of all sensitive branches of the lumbar plexus. These preliminary results suggest that the technique described is effective, safe, minimally invasive, and must be indicated in patients after failure of all other treatments.
authors: Department of Surgical Gynecology and Neuro-Pelveology, Hirslanden Clinic, Witellikerstrasse 40, 8032 Zurich, Switzerland. marc.possover@hirslanden.ch
authors: M
authors: M
authors: Possover
mesh_terms: D004599:Electric Stimulation Therapy; D005260:Female; D006552:Hernia, Inguinal / Q000601:surgery; D059685:Herniorrhaphy / Q000009:adverse effects*; D006801:Humans; D058542:Implantable Neurostimulators; D007264:Inguinal Canal / Q000294:innervation; D010535:Laparoscopy; D010147:Pain Measurement; D010148:Intractable Pain / Q000209:etiology / Q000628:therapy*; D010149:Postoperative Pain / Q000209:etiology / Q000628:therapy*; D019919:Prosthesis Implantation / Q000379:methods*; D060525:Pudendal Nerve