Bjurström, Martin F.;
Nicol, Andrea L.;
Amid, Parviz K.;
Lee, Christine H.;
Ferrante, Francis M.;
Chen, David C.
Neurophysiological and Clinical Effects of Laparoscopic Retroperitoneal Triple Neurectomy in Patients with Refractory Postherniorrhaphy Neuropathic Inguinodynia
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Media type:
E-Article
Title:
Neurophysiological and Clinical Effects of Laparoscopic Retroperitoneal Triple Neurectomy in Patients with Refractory Postherniorrhaphy Neuropathic Inguinodynia
Contributor:
Bjurström, Martin F.;
Nicol, Andrea L.;
Amid, Parviz K.;
Lee, Christine H.;
Ferrante, Francis M.;
Chen, David C.
Description:
<jats:title>Abstract</jats:title><jats:sec><jats:title>Background</jats:title><jats:p>Chronic postherniorrhaphy inguinal pain (<jats:styled-content style="fixed-case">CPIP</jats:styled-content>) is a complex, major health problem. In the absence of recurrence or meshoma, laparoscopic retroperitoneal triple neurectomy (<jats:styled-content style="fixed-case">LRTN</jats:styled-content>) has emerged as an effective surgical treatment of <jats:styled-content style="fixed-case">CPIP</jats:styled-content>.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>This prospective pilot study evaluated the neurophysiological and clinical effects of <jats:styled-content style="fixed-case">LRTN</jats:styled-content>. Ten consecutive adult <jats:styled-content style="fixed-case">CPIP</jats:styled-content> patients with unilateral predominantly neuropathic inguinodynia underwent three comprehensive quantitative sensory testing (<jats:styled-content style="fixed-case">QST</jats:styled-content>) assessments (preoperative, immediate postoperative, and late postoperative). Pain severity, health‐related function, and sleep quality were assessed over the course of a 6‐month follow‐up period.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p><jats:styled-content style="fixed-case">QST</jats:styled-content> revealed marked increases in mechanical, pressure, thermal, and pain thresholds in the areas with maximum pain prior to <jats:styled-content style="fixed-case">LRTN</jats:styled-content> surgery for the immediate (<jats:italic>P</jats:italic> < 0.01; mean 160.9 minutes, range 103 to 255 minutes after extubation) and late postoperative (<jats:italic>P</jats:italic> < 0.05; mean 27.9 days, range 14 to 78 days after surgery) assessments compared to baseline. Wind‐up phenomena were eliminated postoperatively. <jats:styled-content style="fixed-case">LRTN</jats:styled-content> provided robust group‐level improvements of all clinical measures. No preoperative <jats:styled-content style="fixed-case">QST</jats:styled-content> variables were found to be predictive of surgical outcomes. The positive change in heat pain threshold (preoperative compared to late postoperative) showed significant positive correlations with improvements of pain scores and function.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p><jats:styled-content style="fixed-case">LRTN</jats:styled-content> may produce immediate, profound, and consistent positive effects across multiple mechanical, pressure, and thermal <jats:styled-content style="fixed-case">QST</jats:styled-content> variables, and marked improvements of clinical outcomes in selected <jats:styled-content style="fixed-case">CPIP</jats:styled-content> patients. These data contribute to the understanding of mechanisms involved in the success of <jats:styled-content style="fixed-case">LRTN</jats:styled-content>. Large, high‐powered studies are warranted to determine whether preoperative or repeated longitudinal <jats:styled-content style="fixed-case">QST</jats:styled-content> may guide patient selection and predict effectiveness of <jats:styled-content style="fixed-case">LRTN</jats:styled-content>.</jats:p></jats:sec>