title: Efficacy of retroperitoneal triple neurectomy for refractory neuropathic inguinodynia.
abstract: BACKGROUND
  Refractory neuropathic inguinodynia following inguinal herniorrhaphy is a common and debilitating complication. This prospective study evaluated long-term outcomes associated with laparoscopic retroperitoneal triple neurectomy.
  
  
  METHODS
  Sixty-two consecutive patients (51 male; mean age, 47); all failing pain management; prior reoperation in 35, prior neurectomy in 26; average follow-up 681 days (range: 90 days to 3 years). Measured outcomes include numeric pain ratings, dermatomal mapping, histologic confirmation, quantitative sensory testing, complications, narcotic usage, and activity level.
  
  
  RESULTS
  Mean numerical pain scores were significantly decreased (baseline, 8.6) at all postoperative time points (POD 1, 3.6; P < .001: POD 90, 2.3, P < .001) with durable efficacy from POD 90 to 3 years (P < .001). Quantitative sensory testing showed marked group-level increases of sensory thresholds. Narcotic dependence decreased in 57/62 and was eliminated in 44/62 and activity level improved in 58/62.
  
  
  CONCLUSIONS
  Retroperitoneal triple neurectomy is an effective and durable treatment for refractory neuropathic inguinodynia.
authors: Department of Surgery, David Geffen School of Medicine, University of California, 1304 15th Street, Suite 102, Santa Monica, CA 90404, USA.
authors: Alexandra M
authors: AM
authors: Moore
authors: Department of Anesthesiology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
authors: Martin F
authors: MF
authors: Bjurstrom
authors: Department of Surgery, David Geffen School of Medicine, University of California, 1304 15th Street, Suite 102, Santa Monica, CA 90404, USA.
authors: Jonathan R
authors: JR
authors: Hiatt
authors: Department of Surgery, David Geffen School of Medicine, University of California, 1304 15th Street, Suite 102, Santa Monica, CA 90404, USA.
authors: Parviz K
authors: PK
authors: Amid
authors: Department of Surgery, David Geffen School of Medicine, University of California, 1304 15th Street, Suite 102, Santa Monica, CA 90404, USA. Electronic address: dcchen@mednet.ucla.edu.
authors: David C
authors: DC
authors: Chen
mesh_terms: D000328:Adult; D000368:Aged; D003714:Denervation; D005260:Female; D006552:Hernia, Inguinal / Q000601:surgery*; D059685:Herniorrhaphy / Q000009:adverse effects*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009437:Neuralgia / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D010149:Postoperative Pain / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D011446:Prospective Studies; D016896:Treatment Outcome; D055815:Young Adult
keywords: Inguinodynia; Postinguinal herniorrhaphy pain; Triple neurectomy