The Role of Neurectomy in the Treatment of Idiopathic Groin Neuralgia
Shai M. Rozen, M.D.; Sanchit Sachdeva, BA
University of Texas Southwestern Medical Center, Dallas, TX
Background: Chronic groin neuralgia is an extremely life-debilitating condition that plagues patients around the world. While groin neuralgia is usually traced to iatrogenic causes (inguinal hernia repairs, vasectomy, hysterectomy), there is a unique subset of patients that present with idiopathic groin neuralgia. The diagnosis and treatment of these aforementioned patients presents a particular challenge to physicians often leading to unnecessary use of medications or surgery. Thus, idiopathic groin neuralgia is a particularly important etiology to consider.
Materials and Methods: A retrospective and prospective review identified 30 patients (current mean [± SD] age, 52.8 ± 17.1) who presented with idiopathic groin neuralgia and received neurectomies on the Iliohypogastric, Ilioinguinal, and Genitofemoral nerves between 2008 and 2017. Patients were asked to complete a SF-20, identify current use of pain medications, and rate pre-operative, post-operative and current pain on a Likert Scale (0-10). A two-sided Wilcoxon Mann Whitney test was used to analyze the data.
Results: Of the 30 patients identified, 17 agreed to participate (mean follow up= 1832 days) while 4 patients declined and 9 patients were not able to be contacted. Using an established 30% reduction pain as a marker for a successful surgery, 11 of the 17 patients were classified as having a successful surgery while 6 patients were classified as having unsuccessful surgeries (success rate of 64.7%). Patients with successful surgeries showed a statistically significant increase Social Functioning on the SF-20 (p=.0185). In addition, patients with successful surgeries nearly showed a significant increase in Mental Health on the SF-20 (p=.057). Furthermore, clear improvements in mean scaled scores for every SF-20 QoL category were seen when comparing patients with successful and unsuccessful surgeries (Physical Functioning score: 68.2 vs 48.6, Role Functioning: 63.6 vs 41.7, Social Functioning: 80.0 vs 26.7, Mental Health: 78.5 vs 54.0, Health Perception: 57.1 vs 35.7, and Pain: 32.7 vs 60.0).
Conclusions: While there is a lower success rate as compared to the typical post-surgical iatrogenic presentation of groin neuralgia, neurectomy is still a potentially beneficial surgery that can assuage pain and improve QoL for patients with idiopathic groin neuralgia. The limited sample (n=17) may have contributed to the lack of significant differences in QoL measures (other than Social Functioning) between patients with successful and unsuccessful surgeries. However, it is important to note the increases in quality of life seen in all measures of the SF-20, indicating the potential merits of neurectomy for idiopathic groin neuralgia.
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