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General Surgery
Published in Tjun Tang, Elizabeth O'Riordan, Stewart Walsh, Cracking the Intercollegiate General Surgery FRCS Viva, 2020
Rebecca Fish, Aisling Hogan, Aoife Lowery, Frank McDermott, Chelliah R Selvasekar, Choon Sheong Seow, Vishal G Shelat, Paul Sutton, Yew-Wei Tan, Thomas Tsang
You repair the inguinal hernia but he presents 3 months later with chronic groin pain (inguinodynia). How will you manage him?Inguinodynia affects up to 40% of patients.It can be due to neuropathic (local injury) or non-neuropathic (mesh-related) fibrosis of ilioinguinal, iliohypogastric and genital branch of genitofemoral nerves.Risk factors include young age, preoperative pain and pain at other sites.Management: Lifestyle modification, NSAIDs, tricyclics and surgical or chemical neurectomy in selected cases offer a successful recovery, although there is no consensus in the treatment approach.A prophylactic neurectomy during hernia repair significantly decreases the incidence of inguinodynia.Referral to the chronic pain team should be considered if this does not settle with these measures.
Surgical treatment of endometriosis
Published in Caroline Overton, Colin Davis, Lindsay McMillan, Robert W Shaw, Charles Koh, An Atlas of ENDOMETRIOSIS, 2020
Caroline Overton, Colin Davis, Lindsay McMillan, Robert W Shaw, Charles Koh
A trial of presacral neurectomy combined with endometriosis treatment versus endometriosis treatment alone showed that there was an overall improvement in pain relief. The data suggest that this may be specific for midline abdominal pain only. Adverse events were significantly more common for presacral neurectomy, but the majority were constipation, which may improve spontaneously14.
Innervation of Vasa Nervorum
Published in Geoffrey Burnstock, Susan G. Griffith, Nonadrenergic Innervation of Blood Vessels, 2019
Kumud K. Dhital, Otto Appenzeller
VIP may regulate local blood flow and vessel permeability and it could be important in the organizational changes and regenerative processes in both peripheral and central nervous systems. Nevertheless, it is likely that this response to injury is nonspecific. It does occur after neurectomy or bacterial damage to peripheral nerves. Moreover, its importance in clinical situations, particularly causalgia,51 is not known. Injury to nerves produces sympathetic dystrophies including causalgia, and the vasomotor system is markedly affected in many vascular beds of the involved limb but the vasa nervorum in this condition need further study.
Treatment of idiopathic meralgia paresthetica – is there reliable evidence yet?
Published in Neurological Research, 2023
A success rate of 94% of patients undergoing neurectomy was reported in the Cochrane analyses mentioned above [1,2]. These results are based on three studies including 48 cases with a partially pooled analysis of neurolysis and neurectomy data [34,36,44]. A more recent comparative, prospective, observational study in 22 consecutive patients revealed a superior reduction of pain in the neurectomy group (93.3%, n = 14, 1 bilateral case) compared to the neurolysis group (37.5%, n = 8) (p < 0.05). However, these results have to be discussed with caution since the authors did not report on long-term follow-up, recurrence rates, or details on what types of decompression techniques were used. The authors do stress the need for a randomized controlled study on this topic [45]. Neurectomy may have produced better results than neurolysis since frequent findings in the histological sub-analysis revealed focal demyelination, thickened perineurium, subperineurial edema, Renaut bodies, and regenerating clusters [46,47]. One may hypothesize that such changes in nerve morphology are irreversible and therefore only cured by neurectomy [47]. However, clinical data in humans about reversibility of histopathological changes in nerve compression syndromes are missing. Animal models showed a relationship between the duration of symptoms and reversibility of ischemic damage to the nerve induced by compression [48,49].
An investigation of dynamic ulnar impingement after the Darrach procedure with ultrasonography
Published in Journal of Plastic Surgery and Hand Surgery, 2022
Kuan-Jung Chen, Jung-Pan Wang, Hui-Kuang Huang, Yi-Chao Huang
The patients received surgery under general anesthesia. An incision was made on the dorsal side of the wrist, medial to the extensor carpi ulnaris (ECU). Anterior interosseous nerve (AIN) and posterior interosseous nerve (PIN) neurectomy were routinely performed, excising the distal 1–2 cm section. The extensor retinaculum, periosteum, and the distal part of the pronator quadratus (PQ) muscle were elevated to expose the distal ulna. Then ulnar osteotomy was made in a long-sloped shape, and parallel to the contour of the opposing radius. The edges of the ulnar cut were beveled with the saw. The detached distal part of the PQ muscle was transferred dorsally and sutured onto the periosteum sleeve of the ulnar stump, forming an interposition (Figure 2). In the cases with an attritional tear of the extensor tendons, the tendons were explored and reconstructed using the same incision.
Chronic peripheral nerve hyperalgesia in the thoracolumbar region
Published in Baylor University Medical Center Proceedings, 2019
Chikamuche T. Anyanwu, Jelix Thomas, Samantha Dayawansa, Stanley H. Kim, Jason H. Huang
A 42-year-old man with a 19-year history of chronic focal hypersensitivity and hyperalgesia with accompanying numbness and tingling at the right T12 to L1 region presented for neurosurgical evaluation. Previous trials of conservative management, including physical therapy, nonsteroidal anti-inflammatory drugs, muscle relaxants, narcotics, and corticosteroid injections, provided minimal to no relief. Hematologic and basic chemistry levels were unremarkable. Recent magnetic resonance imaging of the thoracolumbar spine was remarkable only for age-related disc degeneration (Figure 1d). No underlying subcutaneous mass or neoplasms was observed. A neuroma was suspected and the patient underwent exploration of his posterior right T12 to L1 subcutaneous area. Intraoperative images showed abnormal subcutaneous material with inflamed subcutaneous nerves deep to overlying scar tissue (Figures 1a, 1b). A neurectomy was performed with the nerves and surrounding tissue specimens collected. Microscopic evaluation of the specimens was performed (Figure 1c). Both specimens were negative for neoplasms. Two-week postsurgical follow-up was unremarkable. The patient noted only mild incisional pain at 3/10 on the pain scale.