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CC BY-NC-ND 4.0 · J Reconstr Microsurg Open 2021; 06(02): e70-e78
DOI: 10.1055/s-0041-1736421
Original Article

Use of Groin Neurectomies for Noniatrogenic Testicular and Groin Pain

Sanchit Sachdeva
1   Department of Plastic and Reconstructive Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
,
Avneesh Chhabra
2   Musculoskeletal Radiology Division, Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas
,
Joan Reisch
3   Division of Biostatistics, Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, Texas
,
Shai M. Rozen
1   Department of Plastic and Reconstructive Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
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Abstract

Background Chronic groin neuralgia is a life-debilitating condition that plagues patients worldwide. While groin neuralgia is usually traced to iatrogenic causes (inguinal hernia repairs, vasectomy, and hysterectomy), there is a unique subset of patients that present with noniatrogenic groin neuralgia. The diagnosis and treatment of these patients present a particular challenge.

Methods A total of 30 patients (current mean age, 46.5 [range: 19–72] years) who presented with noniatrogenic groin neuralgia and received neurectomies on the iliohypogastric, ilioinguinal, and genitofemoral nerves between 2008 and 2017 were identified. A retrospective review of preoperative and immediate postoperative pain scores was compared with prospectively collected current pain on a Likert's scale (0–10). Additionally, patients were asked to complete a Short Form (SF)-20 and identify current pain medications. A two-sided Wilcoxon–Mann–Whitney test was used to analyze the data.

Results Of the 30 patients identified, 16 could participate (mean follow-up = 61 months). The average pain reduction for the entire group was 62.7%. When using an established 30% reduction pain as a marker for clinical significance, 12 successful and 4 unsuccessful patients had an average reduction of 81.1 and 7.68%, respectively (success rate of 75%). Patients with successful group showed a statistically significant increased social functioning (p = 0.012) and near-significant increase in mental health (p = 0.063). Improvements, albeit nonsignificant, in mean scaled scores for every other SF-20 quality of life (QoL) category were observed when comparing both groups.

Conclusion Neurectomy is a potentially beneficial surgery that can assuage pain and improve quality of life for patients with noniatrogenic groin neuralgia.

Keywords

noniatrogenic - groin neuralgia - neurectomy - quality of life


Publication History

Received: 28 March 2021

Accepted: 02 August 2021

Article published online:
18 October 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Cesmebasi A, Yadav A, Gielecki J, Tubbs RS, Loukas M. Genitofemoral neuralgia: a review. Clin Anat 2015; 28 (01) 128-135
    CrossrefPubMedGoogle Scholar
  • 2 Correll D. Chronic postoperative pain: recent findings in understanding and management. F1000 Res 2017; 6: 1054
    CrossrefPubMedGoogle Scholar
  • 3 Kingsnorth A, LeBlanc K. Hernias: inguinal and incisional. Lancet 2003; 362 (9395): 1561-1571
    CrossrefPubMedGoogle Scholar
  • 4 Wu JM, Wechter ME, Geller EJ, Nguyen TV, Visco AG. Hysterectomy rates in the United States, 2003. Obstet Gynecol 2007; 110 (05) 1091-1095
    CrossrefPubMedGoogle Scholar
  • 5 Barone MA, Hutchinson PL, Johnson CH, Hsia J, Wheeler J. Vasectomy in the United States, 2002. J Urol 2006; 176 (01) 232-236 , discussion 236
    CrossrefPubMedGoogle Scholar
  • 6 Parsons B, Schaefer C, Mann R. et al. Economic and humanistic burden of post-trauma and post-surgical neuropathic pain among adults in the United States. J Pain Res 2013; 6: 459-469
    PubMedGoogle Scholar
  • 7 Farrar JT, Young Jr. JP, LaMoreaux L, Werth JL, Poole MR. Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale. Pain 2001; 94 (02) 149-158
    CrossrefPubMedGoogle Scholar
  • 8 Dworkin RH, Turk DC, Farrar JT. et al; IMMPACT. Core outcome measures for chronic pain clinical trials: IMMPACT recommendations. Pain 2005; 113 (1,2): 9-19
    CrossrefPubMedGoogle Scholar
  • 9 Nagarkar P, Ramanadham S, Chamseddin K, Chhabra A, Rozen SM. Neurectomy for the treatment of chronic postoperative pain after surgery of the trunk. Plast Reconstr Surg 2017; 139 (01) 204-211
    CrossrefPubMedGoogle Scholar
  • 10 Nguyen DK, Amid PK, Chen DC. Groin pain after inguinal hernia repair. Adv Surg 2016; 50 (01) 203-220
    CrossrefPubMedGoogle Scholar
  • 11 Poh F, Xi Y, Rozen SM, Scott KM, Hlis R, Chhabra A. Role of MR neurography in groin and genital pain: ilioinguinal, iliohypogastric, and genitofemoral neuralgia. AJR Am J Roentgenol 2019; 212 (03) 632-643
    CrossrefPubMedGoogle Scholar
  • 12 Fritz J, Dellon AL, Williams EH, Rosson GD, Belzberg AJ, Eckhauser FE. Diagnostic accuracy of selective 3-T MR neurography-guided retroperitoneal genitofemoral nerve blocks for the diagnosis of genitofemoral neuralgia. Radiology 2017; 285 (01) 176-185
    CrossrefPubMedGoogle Scholar
  • 13 Chhabra A, Ahlawat S, Belzberg A, Andreseik G. Peripheral nerve injury grading simplified on MR neurography: as referenced to Seddon and Sunderland classifications. Indian J Radiol Imaging 2014; 24 (03) 217-224
    Article in Thieme ConnectPubMedGoogle Scholar
  • 14 Zuniga JR, Mistry C, Tikhonov I, Dessouky R, Chhabra A. Magnetic resonance neurography of traumatic and nontraumatic peripheral trigeminal neuropathies. J Oral Maxillofac Surg 2018; 76 (04) 725-736
    CrossrefPubMedGoogle Scholar
  • 15 Chilla GS, Tan CH, Xu C, Poh CL. Diffusion weighted magnetic resonance imaging and its recent trend-a survey. Quant Imaging Med Surg 2015; 5 (03) 407-422
    PubMedGoogle Scholar
  • 16 Attal N, Cruccu G, Baron R. et al. EFNS guidelines on the pharmacological treatment of neuropathic pain: 2010 revision. Eur J Neurol 2010; 17 (09) 1113-e88
    CrossrefPubMedGoogle Scholar
  • 17 Wan EL, Goldstein AT, Tolson H, Dellon AL. Injury to perineal branch of pudendal nerve in women: outcome from resection of the perineal branches. J Reconstr Microsurg 2017; 33 (06) 395-401
    Article in Thieme ConnectPubMedGoogle Scholar
  • 18 Kachniarz B, Dellon AL. Relief of sitting pain by resecting posterior femoral cutaneous nerve, and elucidation of its anatomical branching pattern. J Reconstr Microsurg 2021; (e-pub ahead of print) DOI: 10.1055/s-0041-1726027.
    Article in Thieme ConnectPubMedGoogle Scholar