Intentionally severing a nerve during inguinal hernia repair
May 2, 2009 1:48 PM   Subscribe

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 (21 answers total) 2 users marked this as a favorite
For clarity: will the numbness be permnament?
posted by popcassady at 2:16 PM on May 2, 2009

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, 2009

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, 2009

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, 2009

Response by poster: 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, 2009

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, 2009

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, 2009

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, 2009

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, 2009

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, 2009 [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, 2009

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, 2009

Best answer: 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, 2009

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, 2009

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, 2009

Response by poster: 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, 2009

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, 2009

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, 2009

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, 2009

Response by poster: 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, 2009

Response by poster: a follow-up for anyone who might find this. i did go ahead and have the surgery done in may of last year, about 8 months ago. during surgery, the surgeon -- according to his dictated notes, which i got for my own records -- thinks that he cut the iliolonguinal nerve on my right leg, but not my left.

my biggest advice to anyone having this surgery is to do your research. my biggest regret was not understanding that i had options that i never knew about.

1) find a surgeon who performs hundreds of hernia repairs every year. that sounds like a lot, but it's not. you don't want a newbie working on you. this is not the right time to "humour someone new on the job". a surgeon who specialises in these repairs might not have the most diverse or interesting job, but he'll give you the best change of having a problem-free recovery. you need to ask your surgeon for the specific # of these surgeries he does.

2) i did not realise that there are different types of patches that can be used for this procedure! although only a few companies make these patches, they offer different "lines", some of which are better but more expensive than others. however the better patches seem to have far fewer complications down the road, less chance of needing to be replaced, and fewer instances of recalls. the one that my surgeon chose was a line that has significant, known problems, but it's the cheapest one available. do your research on the internet, find out beforehand which patch your surgeon will be using, and re-confirm before surgery that he will be using it. you do not want to have your patch removed after the fact!

for me, recovery took a long time, more than a month, including a serious infection at one of the incision sites. to this day, i have significant discomfort and occasional pain from this procedure. half of my right thigh is "numb" and probably will be for the rest of my life. in my left inner thigh i will have the occasional sharp pain as (i imagine) the patch catches on a nerve. i have an enormous amount of scar tissue at one of the incision sites which is very obvious and, of course, unattractive. although these things haven't limited my lifestyle, thankfully, they're a discomfort that i'm sad to realise i may be stuck with for the rest of my life. my biggest disappointment is realising that this cheap patch will probably not last forever, and will start to become brittle and break (a common problem). eventually it will need to be replaced, which is a procedure that sounds worse than even the original surgery.
posted by phoeniciansailor at 10:18 AM on January 11, 2010 [2 favorites]

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