IlioInguinal Neurectomy For Persistent Post Hernia Pain

Of those post hernia pain cases that responded to ilioinguinal nerve freezing block, “complete or partial pain relief was achieved in 66.7%”

J Neurosurg. 2010 Apr;112(4):784-9.
Long-term outcome following ilioinguinal neurectomy for chronic pain.
Zacest AC, Magill ST, Anderson VC, Burchiel KJ. Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon 97239, USA.

• “neuropathic pain was either constant (52.63%) or lancinating [sudden shooting] (74.68%).”
• selective nerve block positive rates were 81% – in keeping with idea most problems are ilioinguinal
• the nerve “pierces the transversus abdominis muscle and crosses the internal oblique muscle.
  From [t]here the nerve travels toward the pubic tubercle under the aponeurosis of the external oblique.”
• Found either cut with neuroma formation, or nerve embedded in scar or mesh.
• “74% of patients recalled that their pain was better at 2 weeks, with 53% reporting improvement of lancinating pain or a reduction in medication”
• “Return of some pain was reported by 68% of patients.”
• Longterm:
  • 27.8% cured (Score 0 of 10 pain);
  • 38.9% partially reduced
  • 16.7% no better
  • 16.7% worse

Comment – Boy, one is really in a lottery here. No wonder so many are left in pain.