Copyright ©2011 Baishideng Publishing Group Co.
World J Gastrointest Surg. Jun 27, 2011; 3(6): 73-81
Published online Jun 27, 2011. doi: 10.4240/wjgs.v3.i6.73
Table 1 Studies showing neurectomy performed by open, laparoscopic or a combination of both open and laparoscopic approach
AuthorCountryNo. of ptsSurgical approachWhich nerve excised?Was mesh excised?Follow-up durationRecurrence/Persistent painComplicationsRemarks
Hameroff et al[49], 1981USA2OpenIINN/ANM2/2NilOnly temporary pain relief following neurectomy
Stulz et al[48], 1982Switzerland5OpenIINN/ANMNo separate data for inguinal hernia patientsNilOut of 22 patients who underwent neurectomy, 5 had previous inguinal hernia repair. In all inguinal hernia cases, IIN was entrapped within the scarred tissue and was excised
Harms et al[30], 1984USA2OpenGFN, IIN + GFNN/A18 mo (patient 1), NM in other patient2/2Wound infection (2)First patient had 2 unsuccessful exploration, followed by successful GFN block and 3rd exploration with GFN neurectomy. Second patient had IIN neurectomy on 1st exploration and due to recurrence of pain further exploration and GFN neurectomy
Starling et al[33], 1987USA26OpenIIN or GFNN/ANM2/13 in IIN group and 3/13 in all GFN group patientsNilNo differentiation possible in GFN group to establish only patients with previous hernia repair. Overall 10 out of 13 with GFN neurectomy were pain free
Starling et al[29], 1989USA31OpenIIN or GFNNMNM2/19 in IINNilSelective nerve blocks used to identify involved nerve(s). In GFN group, no data was given to differentiate those patients who had hernia repair and those who had other abdominal operations
4/12 in GFN
Bower et al[34], 1996USA15OpenIIN, IHN, GFN or LFCNo66 mo3/12NilThree patients had persistent pain following redo exploration. Redo explorations could not identify involved nerve in two patients and identified a recurrent hernia in the other patient
Nahabedian et al[51], 1997USA2OpenIIN, IHN or GFNNM21 mo0/2NilIn one of the patients, no nerve was identified intra-operatively and on the tissue excised, but pain relief was noted post-operatively
Heise et al[11], 1998USA20OpenIIN or IHN or GFNYes16 ± 3 mo8/20Haematoma (1), Testicular atrophy (1)4 patients had only mesh excised and 6 patients underwent selective neurectomy based on operative findings plus mesh excision
Lee et al[53], 2000USA11OpenIIN, IHN, GFN or LFCYes10 moNMHaematoma (1) and recurrent hernia (1)History and clinical examination alone was done for pre-operative assessment. Mesh removal alone did not relieve pain in any patients. IIN was commonly excised. Majority of patients had excellent pain relief, no differentiation could be done to identify those with hernia repair
Deysine et al[32], 2002USA22OpenIINNoNM0/22NilDiagnostic nerve blocks were attempted in all patients. 8 out of 30 patients responded to conservative treatment and the rest were subjected to IIN neurectomy alone. No follow-up data was available and complications were not mentioned
Ducic et al[56], 2004USA4OpenGFN + IINNo9 mo0/4NilAll patients had failed medical treatment. No clear information on diagnosis of nerve entrapment, One patient had previous unsuccessful GFN resection and another patient had previous failed IIN resection
Kim et al[38], 2005USA16 (33 total)OpenIIN, IIN + IHNNM12-46 mo3/33, 10% had recurrent pain, but no clear mention about hernia patientsNM for hernia patients33 patients were operated for CGP, but only 16 had previous hernia repair. Diagnostic nerve blocks done on all patients. Of all 33 patients operated, 91% of IIN neurectomies and 90% of combined IIN + IHN neurectomies were successful
Amid et al[54], 2004USA225OpenTriple neurectomyYes6 mo15% had transitional incisional pain with no functional impairmentNilProposed 1-stage procedure of simultaneous neurectomy of all three nerves without mobilisation of spermatic cord. The nerve ends were implanted proximally into the fibres of internal oblique muscle
Murovic et al[50], 2005USA1OpenGFNNoNM0/1NilTen patients with Genitofemoral neuralgia were analysed, but only one patient had previous hernia repair. Diagnostic nerve blocks were used prior to GFN neurectomy by lateral extraperitoneal approach
Ducic et al[27], 2008USA18OpenIIN, IHN, GFN or LFCNM12-24 mo3/18NilNerve blocks not routinely done. Patients selected for surgical intervention based on history and physical findings
Delikoukos et al[12], 2008Greece6OpenIINYes28 mo0/6NilNo nerve blocks were utilised. Persistent pain in spite of analgesics were indication for surgery in this study. IIN were either excised or freed from the mesh, if entrapped
Vuilleumier et al[24], 2009Switzerland43OpenIIN + IHNYes12 mo2/43Recurrent hernia (1)Diagnosis of neuropathy was done using clinical findings and positive Tinel’s sign. All patients had failed conservative treatment with systemic analgesics, injection of local anaesthetics and steroids, and physiotherapy. Radical neurectomy done in all cases. GFN not excised in any case
Zacest et al[58], 2010USA27OpenIIN, GFNYes35 mo6/19 (followed-up patients)NilDiagnosis was made using selective nerve blocks. Only 19 of the 27 patients responded to telephone follow-up and 67% mentioned either complete pain relief or pain lesser than before
Loos et al[52], 2010Netherlands54OpenIIN, IHN, GFNYes18 mo24%Haematoma (1), wound infection (1), haemorrhage (1), ischaemic orchitis (1)Diagnostic nerve blocks were used in majority of them (78%) and some patients underwent CT or MRI (22%). Tailored neurectomy performed depending on intra-operative findings
Krähenbühl et al[55], 1997Switzerland2Laparoscopic (Retro-peritoneal)GFN and IINNo3 mo0/2NilNo information given about the diagnosis of CGP and indication for laparoscopic neurectomy. Retroperitoneal neurectomy done, but no clear mention about how the nerves were identified intra-operatively
Wong et al[59], 2001Canada1Laparoscopic (pre-peritoneal approach, under fluoroscopic guidance)Nerve not excisedYes (mesh and staples)NM0/1NilSingle patient report with 5 month history of groin pain following laparoscopic hernia repair. Mesh and tackers were found to entrap the IIN and were removed laparoscopically aided by fluoroscopy
Rosen et al[57], 2006USA12Combined open and laparoscopicIIN + IHNYes6 wk0/12NilAll patients had previous open hernia repair and 2 failed percutaneous nerve blocks to treat CGP. TAPP repair done initially, followed by groin exploration, mesh removal and nerve transection. Too short follow-up
Keller et al[41], 2008USA21Combined open and laparoscopicTriple neurectomyYes6 wk1/19 (followed up patients)NilPercutaneous nerve block was unsuccessful in all patients. Initially transabdominal diagnostic laparoscopy was performed irrespective of the route of initial surgery. Mesh was placed in the opposite location to the first mesh (laparoscopic if the first was open and vice-versa). Too short follow-up