Mayagoitia GJC, Baca PJE, Cisneros MHA, Domínguez CLG

Language: Spanish
References: 10
Page: 25-29
PDF size: 230.62 Kb.

ABSTRACT

Introduction: Inguinodynia or chronic postoperative inguinal pain occurs with a frequency that fluctuates between 5 and 15% after hernia repair by any type of approach. Less than 1% will relate to neuropathic pain due to nerve injury. Since endoscopic hernia repair has increased, the resolution of cases with neuropathic pain should be handled exclusively by this same approach. Case report: This is a 66-year-old male with severe Parkinson’s disease. History of 4 right inguinal hernia repair after recurrences, one without mesh, one with a skin plug and two using a synthetic mesh. The last and final, four years ago. He complains of severe, disabling and continuous pain in the inguinal region since his second surgical procedure, treated with oral tramadol every four hours, therefore, he is drowsy most of the time. Dermatome mapping documents involvement of the iliohypogastric, ilioinguinal nerves and genital branch of the genitofemoral nerve. There is no recurrence of the hernia. To perform a laparoscopic triple neurectomy was decided with the patient laid on a lumbotomy position, then three endoscopic ports were placed, locating the involved nerves and then dividing them, a transoperative confirmatory histopathological study was then requested. Its immediate evolution demonstrates complete denervation of the inguinal region according to postoperative mapping, improving its symptomatology. Conclusions: The present case confirms the feasibility of selective or triple neurectomy by a laparoscopic approach in multi-operated cases by an anterior approach or in those after an endoscopic inguinal hernia repair. The precise indication, the approach and the selectivity of the nerves to be divided, are the keys to a successful management of inguinodynia of neuropathic origin.

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