Intentionally severing a nerve during inguinal hernia repair

May 2, 2009 1:48 PM

The surgeon who is going to do my hernia repair says he wants to intentionally sever a nerve that will leave the inside of my thighs numb. The heck??

The doc says that the mesh used to patch up the inguinal hernia can sometimes pull on this certain nerve, leading to chronic pain until the mesh is removed and the surgery re-done. To avoid this (rare) scenario, he says he severs the nerve in question. He says it would leave my inner thighs feeling numb but that I'd get used to it in a few days.

If you've had an inguinal hernia repair, is this something your surgeon discussed with you? How did it work out?

posted by phoeniciansailor to health & fitness (20 comments total)

For clarity: will the numbness be permnament?
posted by popcassady at 2:16 PM on May 2

I have had an inguinal hernia repaired, and I don't remember anything like this.
posted by sevenyearlurk at 2:18 PM on May 2

Get a second opinion... from a doctor. And ask your doctor LOTS of questions. Why do you want to do that? Will it be permanent? Why does the initial operation have that outcome? How frequently?

Ugh. I definitely wouldn't go forward with that without a second opinion. That sounds like a really strange negative impact.
posted by amanda at 2:20 PM on May 2

2nd opinion, for sure. Also, I agree with asking a lot of questions. List them on paper before going in and bring with you. That way you don't forget when you go in. Ask friends/family for general surgeon references. Check him/her out. Don't let surgeon #1 give you the name of a person for 2nd opinion.
posted by 6:1 at 2:31 PM on May 2

The word "permanent" was not used, but "sever" was, so I figured those were synonymous. :) He seemed very casual about it. You know, I'm not a doctor, so during the consultation I defer to his expertise, but I knew I wanted to do more research after I got home. I'm not finding a lot of info on this, though.

I got no feeling that he was Crazy Doc, and he seems like a good guy who does a lot of these surgeries. He has a strong preference for "open surgery" vs. "laproscopic", due to lower recurrece rates, but that doesn't seem unusual after reading around online.
posted by phoeniciansailor at 2:37 PM on May 2

On one hand, there are some nerves in that ballpark that could get in the way--what your doctor is saying doesn't sound totally loopy. On the other hand, that area is close to some favorite things that I really, really would not want to become numb. Put my vote in for 2nd opinion.
posted by gimonca at 2:43 PM on May 2

Get a second opinion. The relationship between patient and doctor involves a lot of information asymmetry. Saying something like that while acting completely casual is how he gets paid thousands of dollars to perform an operation like that.
posted by nel at 2:58 PM on May 2

I recently had just such a procedure - the non-laproscopic hernia repair, not the nerve severing. If my surgeon had blithely said he was going to cut a nerve, I think I'd probably still be walking around with the hernia.

Cut a nerve? What on earth for? And "you'll get used to numb thighs." I definitely would still have a hernia - or else a different surgeon.

On a different note, there's not a lot of pain associated with the procedure, but you do want to have an effective pain-reliever for the first few days. I found, much to my dismay, that I'm impervious to percocet. Still, the worst of it was sitting up to get out of bed.

(Are you absolutely certain this guy wasn't wearing a monocle or have strange lampshades in his office?)
posted by BringaYelve at 3:25 PM on May 2

???
I had an inguinal hernia fixed by surgery too once, and to the best of my knowledge I can still feel my thighs.
posted by Theloupgarou at 3:28 PM on May 2

My husband, who has had this surgery (all nerves intact) says "Wouldn't you risk the positive outcome first?"
posted by annathea at 3:31 PM on May 2 [1 favorite]

I had inguinal hernia surgery many years ago. It resulted in numbness on a few square inches of skin on one inner thigh, near where the scrotum meets the leg. Feeling on the scrotum, penis, etc was not affected. I did get used to it after a while, but the numbness has never really gone away, just diminished over the years. I wasn't aware that a nerve might have been intentionally severed to cause that, assumed it was accidental.
posted by gubo at 4:26 PM on May 2

I had this done a few years ago. Inguinal hernia repair with mesh, non laproscopic. I had a great surgeon (who operated on me after this -that's when you know that you trust a surgeon) and he didn't sever a nerve. I would get a second opinion if I were you.

My experience was like BringaYelve's there is some pain for a few days and sitting up to get out of bed isn't good. Still, the whole thing is a walk in the park compared to a hydrocelectomy!
posted by ob at 4:41 PM on May 2

Your surgeon is probably suggesting severing the illioinguinal nerve, which is recommended because of papers like this showing a decrease in long term (6 month) groin pain/discomfort/numbness.

I've had both the laproscopic "tension free" mesh repair (bilateral), and the "open" lichtenstein type mesh repair, after blowing out my first repair. The open repair caused me more post operative discomfort, but I have little lasting groin pain from either.
posted by zentrification at 5:15 PM on May 2

Even though you really do get used to numb spots, even rather large areas, I would risk a rare complication to avoid nerve damage.
posted by HFSH at 5:22 PM on May 2

See another doctor. My friend had gastric bypass and was getting a free tummy tuck with her hernia repair a few years later, and the plastic surgeon didn't want to give her a bellybutton. She got another doctor who reconstructed one.
posted by IndigoRain at 6:06 PM on May 2

That's fantastic, zentrification. That's exactly what he's talking about. Apparently "neurectomy" is the doctor-y word for "sever", which may explain my poor results when Googling on my own. :) So I'm looking at the study that you linked to, and it looks like there might be some benefit to having the nerve removed. The statistics where: in the group of 50 who had the nerve removed, 4 still complained of chronic pain after 6 months. In the group of 49 who had the nerve left in tact, 14 complained of chronic pain after 6 months. According to the study, the first group didn't seem to think the numbness was significant or lowered their quality of life.

That's interesting. I'm not sure -- you know -- how much I should trust the study exactly, but it's definitely interesting. I think I'll check with my surgeon to see about the possibility of leaving the nerve intact for now, and then -- if I do have significant, ongoing pain -- having it removed after 6 months. If that's possible, and a fairly simple procedure, maybe I'll opt for that.

Thanks for the help! It feels good to be better informed.
posted by phoeniciansailor at 6:26 PM on May 2

I had an inguinal hernia repair done almost 9 years ago. This was never discussed by the doctor, and I don't think he did it -- I seem to have as much feeling on the inside of my thighs as ever.
posted by Artifice_Eternity at 7:39 PM on May 2

Just FYI, the -ectomy suffix is the part that means "sever" or "remove", and neur- refers to the nerve.
posted by kosmonaut at 8:26 PM on May 2

FYI--removing mesh down the road can be complicated. (Just thought you should know that going in). I would include that with your questions for your surgeon.
posted by 6:1 at 10:42 PM on May 2

i talked to my surgeon and he confirmed that it was the ilioinguinal nerve he had talked about removing. he said the evidence was still out on whether or not it was very beneficial, but he says he's been removing the nerve in nearly all patients in the last 3 years without anyone having anything bad to say about it. *shrugs*

fyi: we agreed that he'd leave the nerve intact for me, unless it became damaged during surgery in which case i told him he could remove it since i'd rather not have the problems associated with a damanged nerve. (i'll be knocked out for the procedure so have to get these things settled up front :)

he says that going back later to remove the nerve -- if i did wind up having chronic pain from the hernia repair -- is an option, but that is entails basically the same wounds to be re-opened and that it's not a simple in-office procedure or anything.
posted by phoeniciansailor at 9:35 PM on May 12