RETROPERITONEAL ENDOSCOPIC NEURECTOMY FOR NERVE ENTRAPMENT AFTER HERNIA REPAIR

Background Entrapment neuralgia after open and laparoscopic hernia rep air occurs in about 1-2 per cent of patients. If the pain persists acc urate identification of the nerve involved and surgical treatment is a n option. Entrapment neuralgia of the genital branch of the genitofemo ral nerve and ilioinguinal nerve occurs, but damage to the femoral bra nch of the genitofemoral nerve, the lateral femoral cutaneous nerve an d the femoral nerve is also described. This paper reports an endoscopi c technique for neurectomy. Methods A balloon catheter is inserted blu ntly into the lower retroperitoneum and insufflated to create a work s pace. Neurectomy is performed under endoscopic guidance. Results Three men with a mean age of 39 years were treated using this technique. A neurectomy of the genitofemoral nerve was performed in all three and i n one neurectomy of the ilioinguinal nerve was also done. The mean ope rating time was 70 min and all the patients were completely pain-free after surgery. All patients were discharged within the first 2 days af ter operation and there were no complications. Conclusion This retrope ritoneal endoscopic technique is proposed as a new surgical approach f or treating entrapment neuralgia. It is simple and effective at reliev ing symptoms.