V-022 POSTOPERATIVE INGUINODYNIA: LAPAROSCOPIC NEURECTOMY AND MESH REMOVAL

Abstract

Abstract Aim Chronic groin pain following a hernioplasty is a complication with an incidence of 10–12%. A multidisciplinary approach, including pain management services, interventional radiology and surgery, has proven the best outcomes. Persistence of symptoms and lack of efficacy of non-surgical treatments make surgical treatment with prosthetic removal and neurectomies an appropriate alternative. Material & Methods We present the clinical case of a 35-year-old male with a history of bilateral laparoscopic groin hernioplasty performed at another institution 10 years ago. After the surgery, he developed chronic groin pain, predominantly on the left side, and underwent multiple interventions. He complained that the pain was severe and incapacitating, affecting his quality of life. Dermatome mapping evidenced compromise of the three inguinal nerves (ilioinguinal, iliohypogastric and inguinal branch of genitofemoral). A multidisciplinary approach including NSAIDs, pregabalin, tricyclic antidepressants and periradicular blocks followed by radiofrequency ablation was established, without success. A laparoscopic left inguinal exploration with mesh removal and triple neurectomy was then decided. Results The patient had an adequate postoperative course. He returned to daily activities including sports practice, and no recurrence was observed after 1 year of follow up. Conclusions A multidisciplinary approach is suggested for the treatment of postoperative inguinodynia. Neurectomy and mesh removal is a safe and effective strategy, and must be considered for the management of severe postoperative groin pain in which non-operative approaches failed. Surgery entails a great challenge and therefore should be performed in specialized centers.