P008 Laparoscopic triple neurectomy for chronic groin pain after hernial repair (chronic inguinodynia) in adult male. 1st reported case in Sri Lanka.

<h3></h3> <b>Please confirm that an ethics committee approval has been applied for or granted</b>: Not relevant (see information at the bottom of this page) <h3>Background and Aims</h3> Introduction Chronic postoperative inguinal pain, CPIP has a pooled incidence of 11% -16.8% and it is severely disabling in 2%-6% of cases.1,2 This can be of neuropathic or non neuropathic in origin. Characteristics sharp, burning or ’shooting’ sensation is felt in the distribution of ilioinguinal, genitofemoral and iliohypogastric nerves. Management includes analgesics, nerve blocks. trans-cutaneous electric nerve stimulation, pulsed radio-frequency, nerve root blocks. Surgical interventions are considered as the last option when other methods failed.3 <h3>Methods</h3> Case report A 54-year-old man presented with a history of intractable left sided groin pain for 3 years following left recurrent inguinal hernia repair. Burning type of pain was experienced in groin, scrotum and upper part of inner thigh. No signs of hernial recurrence or radiological evidence of meshoma. Pharmacological management was unsuccessful and nerve blocks gave partial and short term improvement. Laparoscopic retroperitoneal triple neurectomy was done under general anaesthesia transecting the 3 nerves. Marked improvement of symptoms observed in immediate post op period and good quality of life during the review in 3 months after the procedure. <h3>Results</h3> Discussion Inguinal hernia repair is one of the commonest surgical procedures. CPIP is a debilitating complication independent of surgical method.4 Patients require multidisciplinary assessment and non surgical treatment as first line management. All patients should undergo diagnostic and therapeutic nerve block prior to neurectomy. Laparoscopic retroperitoneal approach is minimally invasive, facilitate nerve identification with minimal complications. Effectiveness can be assessed in the immediate post operative period.5