Kelly Haisley, MD, Michael Antiporda, MD, Richard Jamison, MD, Christy Dunst, MD, Lee Swanstrom, MD. Providence Portland Medical Center
Introduction: In this video, we review a case of a minimally invasive neurectomy using a hybrid laparoscopic/robotic device for the treatment of chronic groin pain after open inguinal hernia repair.
Background: The patient is a 38 year old man suffering from chronic debilitating groin pain after an open inguinal hernia repair with mesh several years ago. While reoperation and mesh excision with ilioinguinal nerve resection helped improve the patients symptoms and limit the distribution of his pain, he continued to have intolerable neuropathic discomfort in his lower abdominal wall and groin. Understanding that the nerve distribution to the inguinal region is complex with innervation from multiple branches of the lumbar plexus, it has been suggested that a triple neurectomy, taking not only the ilioinguinal nerve, but also the iliohypogastric and genitofemoral nerves may provide long term pain relief in patients with chronic discomfort in the distribution of these nerves. Given that our patient had a fairly typical pain distribution along the inguinal canal and a good response in the ilioinguinal nerve distribution with ligation, the decision was made to proceed to the OR for minimally invasive completion of a triple neurectomy. As the ilioinguinal nerve had already been ligated, this wound include exploration for and division of the remaining iliohypogastric and genitofemoral nerve branches.
Methods: The video that follows demonstrates a laparoscopic transabdominal pre-peritoneal approach to inguinal neurectomy using a hybrid laparoscopic-robotic device. The video highlights the identification of the relevant anatomy and provides guidance on how to safely perform this procedure utilizing cutting edge equipment.
Conclusion: While chronic groin pain can be a debilitating and difficult to treat condition after inguinal hernia repair, triple neurectomy offers a treatment option that can be safely implemented through a minimally invasive technique, and may be highly beneficial in appropriately selected patients.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95855
Program Number: V089
Presentation Session: Inquinal and Ventral Hernia
Presentation Type: Video