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long term efficacy of triple neurectomy

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  • long term efficacy of triple neurectomy

    I have been living with significant groin pain since having mesh removal after an inguinal hernia repair and a neurectomy. I am considering a triple neurectomy but can't find anything on long term outcomes. Nor have I found anyone who had this procedure who can attest to the longer term outcome. If anyone can help me out with this it would be much appreciated.
    Thank you
    Alan

  • #2
    I canít personally help in the sense that I havenít had any bit I do know that there seems to be a debate from the textbook literature on the groin nerves and real life experiences.
    There are people out there that have had long term issues with neurectomies as they pertain to sexuall dysfunction and abdomen muscle atrophy/weakness. It seems they may not only be sensory nerves but motor as well.
    if you google the Dellon institute he has a wealth of information on this subject matter and maybe someone with

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    • #3
      Worth contacting as he specializes in nerve issues and groin pain.

      Comment


      • #4
        I think that there are injections that you can try beforehand that will tell if a neurectomy will help. DrBrown is familiar with them.


        Can you give more detail on your activities since mesh removal? I found that, while healing from my own mesh removal, certain pain was resolved by being more active. Running or hiking, even though it seemed counterintuitive. Rest did not help at all. There seemed to be dead zones that needed help to get fluid moving, to promote healing. Dr. Bendavid's work on a potential reason for mesh-induced pain was illuminating. Nerves need good blood supply to be healthy.

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        • #5
          Make sure your surgeon is skilled and aware of risks associated with neurectomies. Prior to committing to them, nerve blocks and even nerve stimulator may be a good choice.

          The nerves have motor function the closer they are to the spine. More distally, they become mostly sensory, so cutting them in the front (anterior, open) has less abdominal weakness issues.

          The sexual dysfunction described by some is not directly related to the neurectomy. Itís often related to chronic pain and use of opioids.
          #ItsNotJustAHernia
          www.BeverlyHillsHerniaCenter.com

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          • #6
            Originally posted by allj View Post
            I have been living with significant groin pain since having mesh removal after an inguinal hernia repair and a neurectomy. I am considering a triple neurectomy but can't find anything on long term outcomes. Nor have I found anyone who had this procedure who can attest to the longer term outcome. If anyone can help me out with this it would be much appreciated.
            Thank you
            Alan
            I received mesh removal and triple neuroctomy. I am in a worse situation. Dont do it.

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            • #7
              "One wrong turn just one wrong turn". Thanks to everyone.
              I will definitely contact the Dellon institute.

              Dr. Towfigh your good advice is always appreciated.
              I assumed the weakness I have is because I had an alloderm replacement and the mesh removed. I am currently talking to a skilled surgeon about doing a lap repair (since the other repairs were done openly) in hopes of strengthening the area. Does this make sense? (my thinking is that I'm 73 and if I get much older and the alloderm/collegen doesn't hold I'll be too old to operate on)

              Good intentions - I had mesh removal and a single neurectomy of the inguinal nerve ~
              12 yrs ago
              . I have also kept active - mostly bike, exercising and hiking but when I'm not active for a short time I'm in slow agony - death by a 1000 cuts. Activity seemed to keep the nerve activity down and the area feels stronger but more recently exercising has aggravated the groin hernia repair area causing significant innervation elsewhere in the area and weakness. Even standing, I had little strength and walking reverberated pain in the area. The surgeon prescribed a steroid pack and nsaids and after 3 weeks I am starting to exercise again. He also suggested getting a triple neurectomy with Dr. Chen. After reading the helpful comments I realize this isn't a fix-all and may be misery. I'm leery of doing it.
              Thank you all - so glad and thankful there are people like you
              Alan

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              • #8
                To treat pain after mesh hernia repair it is important to try to determine the exact cause of the pain. Check for a recurrent hernia. A nerve block will help determine if the nerves are involved. The mesh can also be injected with local anesthesia to help determine if the mesh is the source of the trouble. Other structures that can be also be injected such as the inguinal ligament, the spermatic cord, etc. Once the etiology of the pain is identified the appropriate plans can be made.
                Mesh pain is a difficult problem and is the source of my gray hair.
                Regards.
                Bill Brown MD

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                • #9
                  Thank you DrBrown. This info really helps. All I have to do now is find someone who will follow this plan.
                  Alan

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                  • #10
                    Originally posted by DrBrown View Post
                    To treat pain after mesh hernia repair it is important to try to determine the exact cause of the pain. Check for a recurrent hernia. A nerve block will help determine if the nerves are involved. The mesh can also be injected with local anesthesia to help determine if the mesh is the source of the trouble. Other structures that can be also be injected such as the inguinal ligament, the spermatic cord, etc. Once the etiology of the pain is identified the appropriate plans can be made.
                    Mesh pain is a difficult problem and is the source of my gray hair.
                    Regards.
                    Bill Brown MD
                    I came across an accredited site where a surgeon questioned colleagues about the opportunity to practice preventive neurectomy in elective surgery to avoid possible chronic pain. Fortunately, almost all the colleagues from all parts of the world have especially supported the need to preserve nerves. Even when a nerve was wrongly damaged during the elective procedure, it could be caustic. Also for dont risk to damage the nervs in the surgery which occurs in the case of incidental resection or stress, some doctors instead practice a preventive neurolysis ...what do you think about preventive neurolysis, is it a safe practice to preserve nerves?
                    Last edited by saro; 4 weeks ago. Reason: add a question

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                    • #11
                      I am not aware of preventive neurolysis. That doesnít make any sense. Only neurectomy. Some do it for inguinal hernias. Studies donít support any particular method. Many of us experts recommend not disturbing the nerves during primary (first time) inguinal hernia repair. In mesh removal, neurectomy may be necessary.
                      #ItsNotJustAHernia
                      www.BeverlyHillsHerniaCenter.com

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                      • #12
                        Dr. Towfigh -
                        I'm not sure my question
                        about the long term efficacy of triple neurectomies was
                        answered. I only found one study regarding long term outcomes of triple neurectomy. It reported that "
                        The mean follow-up duration was 34.78 months. Return of pain was reported by 13 (68%) of 19 patients. Using a verbal numerical rating scale (0-10), pain was completely relieved in 27.8%, better in 38.9%, no better in 16.7%, and worse in 16.7% of patients."
                        Is this due to the way the procedure was done or is this what I can expect?
                        Thanks Alan

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                        • #13
                          This paper discusses neurectomy for chronic pain. That is a different situation from elective or prophylactic neurectomy. Also, it was done by neurosurgeons. Thatís a different situation than treating chronic pain by a hernia expert. Post inguinal hernia repair chronic pain is often more complex than a single neuroma.
                          #ItsNotJustAHernia
                          www.BeverlyHillsHerniaCenter.com

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                          • #14
                            I read that prophylactic neurolysis would be preferable to prophylactic surgical blocking of the nerves, because it interrupts the sensoriality, injuring a nerve, but saving its basal lamina, where the nerve will grow back. While the surgical block also cuts the basal lamina.

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                            • #15
                              I donít agree with that
                              #ItsNotJustAHernia
                              www.BeverlyHillsHerniaCenter.com

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