Surgical management of inguinal neuralgia after a low transverse Pfannenstiel incision.

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.

• Authors: Maarten J A Loos, Marc R M Scheltinga, Rudi M H Roumen
• Journal: Annals of surgery (Ann Surg) Vol. 248 Issue 5 Pg. 880-5 (Nov 2008) ISSN: 1528-1140 [Electronic] United States
• PMID: 18948818 (Publication Type: Journal Article)

Topics

• Abdomen (innervation)
• Adult
• Aged
• Algorithms
• Cesarean Section
• Coitus
• Female
• Foreign Bodies (complications)
• Gynecologic Surgical Procedures (adverse effects)
• Humans
• Hysterectomy
• Inguinal Canal (innervation)
• Middle Aged
• Nerve Block
• Nerve Compression Syndromes (etiology, surgery)
• Neuralgia (etiology, surgery)
• Pain Measurement
• Patient Satisfaction
• Peripheral Nerves (surgery)
• Retrospective Studies
• Risk Factors
• Sutures (adverse effects)
• Treatment Outcome