Ilioinguinal Pain

Ilioinguinal Pain

Definition

Ilioinguinal pain is caused by surgical lesions affecting different nerves in the small pelvis, such as the ilioinguinal nerve, the genital femoral nerve or the lateral femoral cutaneous nerve. Typical examples include wounding during the removal of lymphatic ganglions or during inguinal hernia surgery, the latter scenario being particularly frequent. Laparoscopy that is not carried out correctly can also lead to nerve wounds. Such is the case, for instance, when the spreading trocar (the tool used to maintain an opening for access during surgery) is inserted too deeply and too laterally in the abdominal cavity.

 

This type of pain, which irradiates into the groin, usually appears soon after surgery if a nerve has undergone direct trauma. In contrast, pain that is caused by the subsequent formation of scar tissue may not appear until several months later.

Treatment

Decompression techniques (neurolysis or others) applied to small nerves that innervate the abdominal wall usually yield poor results. Such nerves are extremely difficult to locate and it is nearly impossible to free a nerve embedded in post-operative scar tissue. This is particularly true if mesh is placed over the skin following inguinal hernia surgery. Moreover, if the nerves are extensively damaged, simply freeing them will not suffice to eliminate the pain. The sectioning of damaged nerves does not yield satisfactory results either: although it rapidly relieves pain in most cases, it also causes loss of all sensations in the groin. Pain may also return after several months due to the development of neuromas at the site where the nerves were sectioned. The returning pain is often more intense than before the treatment.

 

As a consequence, neuromodulation is currently the only efficient and successful way to treat ilioinguinal pain. Other methods, such as various techniques to implant electrodes in the abdominal cavity, lack precision and do not yield the desired results. In contrast, abdominal laparoscopy that reaches behind the kidneys provides access to inguinal nerves before their entry into the abdominal wall. An electrode can thus be precisely positioned on the damaged nerve with minimal effort and minimal invasion. Postoperative pain relief is then possible by selective neuromodulation.