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Suprainguinal re-resection of the lateral femoral cutaneous nerve in persistence or recurrence of meralgia paresthetica after previous transection: results of a case series
Godard C.W. de Ruiter, MD, PhD, Haaglanden Medisch Centrum, The Hague, Netherlands, Pieter Clahsen, MD, Medical Center Haaglanden, The Hague, Netherlands and Wolter Oosterhuis, MD PhD, Medical Center Haaglanden, Tha Hague, Netherlands

Objective
Neurectomy of the lateral femoral cutaneus nerve (LFCN) can be performed to treat symptoms of meralgia paresthetica. Sometimes this procedure is performed if neurolysis has failed, sometimes also as primary procedure. Successful pain relief is observed in about 85% of the cases after transection of the LFCN. Sometimes symptoms of meralgia paresthetica may persist or recur, in the latter after a pain free interval of at least several months. Suprainguinal re-resection of the proximal nerve stump of the LFCN may then be an option. The technique has been described before, but up to now there is no case series that has described the long-term results for this procedure.
Material and methods
Twenty consecutive patients with persistent (13 cases) or recurrent (7 cases) symptoms of meralgia paresthetica were re-operated at a mean interval of 16 months after the first transection of the LFCN. The proximal nerve stump was sent for histopathologic analysis. Outcome was assessed using a 5-point Likert scale, which was obtained by mail or telephone. The study was approved by the Medical Ethical Committee. Informed consent had been given by all patients.
Results
There was 100% follow-up at a mean interval of 3.5 years after the suprainguinal re-resection. Intra-operatively, the proximal stump of the LFCN could be identified in 18 out of 20 patients. Successful pain relief (Likert 1 or 2) was obtained in 13 out of 20 patients (65%). A traumatic neuroma was found in 11 cases (55%) and in all cases for the indication of recurrence of symptoms after a painfree interval. Statistical analysis was performed on the 18 cases in which the proximal stump had been found. Fisher's exact test showed no difference in percentage pain relief for indication (persistence or recurrence) and no correlation for the presence of a neuroma and the chance for pain relief.
Conclusions
Suprainguinal re-resection of the LFCN can be a successful procedure, both for persistence and recurrence of symptoms of meralgia paresthetica after previous transection, with long-lasting pain relief. The success after recurrence of symptoms obviously can be explained by resection of the traumatic neuroma. More research is needed to explain the observed success for cases with persistence of symptoms.


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