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surgeons who practice preventive neurectomy

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  • surgeons who practice preventive neurectomy

    incredibly, there are surgeons who practice preventive neurectomy
    I came across an accredited site where a surgeon questioned colleagues about the opportunity to practice preventive neurectomy in elective surgery to avoid chronic pain. Normally if a nerve was damaged incorrectly during the procedure, it could be caustic. However somewhere I read that the inevitable cut produces a hypoesthesia. It would be interesting to know if the hypoesthesia is reversible. Some say that cutting the nerve with its conduit does not allow the nerve to reform itself; still others that the nerves could reform. Finally, some authors do not seem to rule out the risk of a neuroma even in the case of this neurectomy
    P.S. I apologize for my English translation
    Last edited by saro; 4 weeks ago. Reason: Insert tag and translation check

  • #2
    https://www.researchgate.net/post/Wh..._or_neurectomy

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    • #3
      to avoid permanent nerve damage, which occurs in the case of incidental resection or stress, some doctors instead practice a preventive neurolysis ... from what I could understand neurolysis is a practice used especially in the case of irreducible pain, however it is not equivalent to nerve cutting (neurectomy) and differs from nerve block ... but of the three practices mentioned, only neurolysis is practiced during a primary intervention in some specialists, but I don't know how successful ...it would be interesting to know the opinion of the doctors of the site on neurolysis, the drtowfigh pls
      if they read me, because this subject is of strict competence for the specialist doctors and for anesthesiologists ..

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      • #4
        Dear Saro.
        Preventive neurectomy only started after mesh was introduced. Sometimes after hernia repair the nerve can become scarred to the mesh resulting in pain.
        There are three major nerves in the inguinal area. The iliohypogastric nerve, the ilioinguinal nerve, and the genital nerve. The iliohypogastric nerve provides sensation to the pubic hair area and the upper part of the scrotum or Mons. The ilioinguinal nerve provides sensation along the inguinal ligament, on the inside of the upper thigh, and on the outside of the scrotum or Mons. The genital nerve provides innervation to the cremasteric muscles and sensation to the testicle or labia majora.

        Damage to any of these nerves can cause chronic pain after the surgery. Some surgeons advise routine transection of these nerves to avoid postoperative pain. But cutting the nerves causes the skin to be numb. And if the nerve tries to grow back and a neroma forms, then that can be a source of cause chronic pain. It is best to carefully identify the nerves during the operation. And then take care not to damage the nerves while the hernia is being repaired.

        The iliohypogastric nerve can usually be identified running parallel to the inguinal ligament about a centimeter above the level of internal ring and deep to the external oblique aponeurosis. It will emerge through a hole in the external oblique aponeurosis just above the external inguinal ring and continue its journey to the skin.

        The ilioinguinal nerve joins the spermatic cord (or round ligament in women) at the internal inguinal ring and then runs along the anterior superior aspect the spermatic cord (or round ligament).

        The genital nerve usually joins the spermatic cord (or round ligament) at the internal inguinal ring and then runs along the posterior aspect of the spermatic cord (or the round ligament). Of the three nerves, the course of genital nerve is the most variable. Instead of traveling with the spermatic cord (or round ligament), it can be found near the inguinal ligament or running along the floor of the inguinal canal.
        Regards.
        Bill Brown MD

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        • #5
          Thank you Dr. Brown for your thorough response.

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