Surgical Management of Genitofemoral Neuralgia

Abstract

Video Objective This video reviews the etiology, diagnosis, and management of genitofemoral neuralgia which is defined as pain along the distribution of the genitofemoral nerve. Setting The patient in this video began having symptoms of genitofemoral neuralgia following a laparotomy. A common mechanism of iatrogenic injury to this nerve is crush injury from poorly placed self-retaining retractors during abdominopelvic surgery. A neurectomy can be offered because the genitofemoral nerve has only sensory function and no motor function. Interventions We review the surgical technique for resection of the genital branch of the genitofemoral nerve. This technique involves retroperitoneal dissection over the psoas muscle, identification of the bifurcation of the nerve into its femoral and genital branches, isolation of the nerve, resection of the nerve, and implantation of the proximal nerve ending into the psoas muscle for nerve regeneration and neuroma prevention. Conclusion This technique is 66-100% in successful in relieving symptoms including the case of this patient.