Surgical Management of Inguinal Neuralgia After a Low Transverse Pfannenstiel Incision

Maarten J A Loos, Maarten Loos, Loos MJ, Scheltinga MR, Marc R M Scheltinga, Marc R. Scheltinga, Rudi M. H. Roumen, Roumen RM
Annals of surgery · 2008 · vol. 248(5) , pp. 880–885 · doi:10.1097/sla.0b013e318185da2e · PMID:18948818 · W1983985809
article OA: closed CC0 ⤵ 2 in-corpus citations
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This study evaluated nerve blocks and neurectomy for Pfannenstiel-incision-related neuralgia, finding neurectomy safe and effective in most patients after diagnostic blocks failed.

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Abstract

OBJECTIVE: The authors assessed the long-term pain relief after local nerve blocks or neurectomy in patients suffering from chronic pain because of Pfannenstiel-induced nerve entrapment. SUMMARY BACKGROUND DATA: The low transverse Pfannenstiel incision has been associated with chronic lower abdominal pain because of nerve entrapment (2%-4%). Treatment options include peripheral nerve blocks or a neurectomy of neighboring nerves. Knowledge on adequate (surgical) management is scarce. METHODS: Patients treated for iliohypogastric and/or ilioinguinal neuralgia after a Pfannenstiel incision received a questionnaire assessing current pain intensity (by 5-point verbal rating scale), complications, and overall satisfaction. RESULTS: Twenty-seven women with Pfannenstiel-related neuralgia were identified between 2000 and 2007. A single diagnostic nerve block provided long-term pain relief in 5 patients. Satisfaction in women undergoing neurectomy (n = 22) was good to excellent in 73%, moderate in 14%, and poor in 13% (median follow-up, 2 years). Complications were rare. Successful treatment improved intercourse-related pain in most patients. Comorbidities (endometriosis, lumbosacral radicular syndrome) and earlier pain treatment were identified as risk factors for surgical failure. CONCLUSIONS: Peripheral nerve blocking provides long-term pain reduction in some individuals. An iliohypogastric or ilioinguinal nerve neurectomy is a safe and effective procedure in most remaining patients.

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Condition tags

endometriosis

MeSH descriptors

Gynecologic Surgical Procedures Inguinal Canal Nerve Block Nerve Compression Syndromes Neuralgia Peripheral Nerves Abdomen Abdomen Adult Aged Algorithms Cesarean Section Coitus Female Foreign Bodies Foreign Bodies Gynecologic Surgical Procedures Humans Hysterectomy Inguinal Canal

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