Usually performed for the treatment of Meralgia
Paresthetica. This is when the nerve that runs to
the outside of the thigh, just below the hip and above
the knee, is compressed or not functioning correctly.
This nerve is called the Lateral Femoral Cutaneous Nerve
The sharp bend in the nerve may allow the nerve to
be stretched and therefore damaged in the inguinal
Stretching of the nerve may be caused by being overweight,
causing the nerve to lengthen in the thigh.
Compression of the nerve caused by overly tight clothing
or belts can also be a cause.
Repetitive trauma to the nerve.
- Constant pressure on the nerve in long face down
surgery, usually spine surgery.
- Often there is no specific cause.
What are the reasons for having the operation?
The commonest reason is that the symptoms in your leg
have been causing significant discomfort, or that the
symptoms are getting worse. Usually non-operative therapy
What are the types of surgery?
- Trial steroid and local anaesthetic injection around
the nerve. This may cause permanent improvement and
is also diagnostic, allowing Mr. D'Urso to confirm
the site of the nerve.
- Decompression of the nerve in the inguinal ligament
with a transverse cut in the thigh to get the nerve.
- Division of the nerve at the inguinal ligament
with a transverse cut in the thigh to get to the nerve.
This usually is the best surgical alternative.
What operation is performed?
Prior to the consideration of surgery all patients
will have a trial of injection of local anaesthetic
and steroids around where the nerve normally is. This
is done at a time prior to any surgery. This should
send the nerve completely to sleep and usually relieves
the pain. The sensation loss will be temporary but the
relief of symptoms will commonly be prolonged and may
be permanent. A small needle will be inserted around
the nerve and the drugs injected.
The operation can be either division of the nerve or
decompression. Usually Mr. D'Urso will try to decompress
the nerve as the initial procedure. This is not as effective
as division of the nerve but it gives a chance of maintaining
sensation which will be lost with nerve division. The
surgery can either be performed under a local or general
anaesthetic. You may be admitted as a day patient and
go home after the operation or be admitted the day before.
Regardless of the type of anaesthetic, you will not
be qable to eat or drink from midnight before the operation.
What happens at the operation?
Firstly, the leg to be operated on is confirmed and
the incision line is drawn on the skin at the groin.
If the operation is under local anaesthetic then this
will be injected into the wound at this time (a sedative
is given by the anaesthetist to help the operation pass).
If under general anaesthetic, you will go off to sleep
after the marking of the incision. The incision is then
washed with antiseptic solution and the leg is covered
with drapes to leave only the area of the incision exposed.
Mr. D'Urso then cuts through the skin and fat down
to the first fascia layer. He will then cut through
the fascia over the muscle and the nerve with a sharp
scapel. The nerve is identified as it runs beneath this
fascia. He follows the nerve up to the inguinal ligament
and finds the point where it comes through. If the nerve
is decompressed then this hole is opened up. If the
nerve is to be divided then the nerve is lightly pulled
on to pull it through the hole. It is then cut and the
stump will withdraw back into the abdomen.
Mr. D'Urso then makes sure all the bleeding has stopped
and sews the skin and the layer underneath back together.
The wound is then covered with a dressing and you are
then sent to the recovery room.
What happens next?
You will wake up in the recovery room and after about
one hour you will be transferred to the ward. The nursing
staff will be continously checking your pulse/blood
pressure/limb strengths and sensation looking for any
changes to indicate a complication. You will probably
only need oral analgesia. Most people will be able to
go home the same day. It is important that someone drives
you home afterwards.
The sutures are usually removed about 7-12 days after
the surgery if they are not dissovable.
What you should notify your doctor of after surgery?
- Increasing pain in the wound/groin.
- Swelling or infection in the wound.
If the nerve is divided there will be a patch of numbness
on the side of the leg. This will reduce over time but
will not completely go away.
What happens when you go home?
- The covering dressing should be changed second daily
from the second day or if it gets wet.
- You will have an early follow-up appointment to
have your wound reviewed.
- You must not run or stress the leg until you are
advised you can do so by Mr. D'Urso.
- It is important to keep the wound dry.
- Mr. D'Urso will discuss driving and return to work
What are the risks?
Please discuss these with Mr. D'Urso at your appointment.
The common risks are:
- The nerve cannot always be found as it may come
out in an unusual place. If you have had a result
from the injection we can usually find the nerve.
- Infection (treated with antibiotics).
- Post-operative blood clot requiring drainage.
- Nerve damage.
- Wound pain.
- Scar in the wound area.
- Failure of symptoms to improve.
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