Implanting the proximal stump of the nerve in the inguinal fat tissue as an effective technique to avoid inguinal pain after accidental inguinal nerve transection: Case report()

INTRODUCTION: A neuroma can occur after the inguinal nerve is injured by accident during the inguinal repair surgery. The neuroma, formed at the tip of the proximal site of the transected inguinal nerve, promotes the growth of neuroma fascicles and causes a painful/tingling sensation if tapped or pressed on the inguinal area. PRESENTATION OF CASE: To decrease the neuropathic pain caused by accidental transection of the inguinal nerve, the proximal stump of the transected inguinal nerve is implanted into the subcutan fat tissue in the inguinal area through a different opening away from the incision of the external oblique aponeurosis. DISCUSSION: The incapability of white adipose or fat tissue in promoting nerve fiber regeneration is due to the absence of neurotrophic factors in the inguinal subcutaneous white fat tissue. The white fat tissue is not invaded by neuroma fascicles as it usually occurs in brown fat tissues or other connective tissues where the neurotrophic factor is abundant. In the manuscript, we reported 2 cases of accidental transections of inguinal nerve in open hernia repair surgery, the proximal stump of the transected nerve was implanted in the inguinal-subcutan fat tissue. No neuropathic pain has been reported by these patients since 2015 and 2017, respectively. The hypoesthetic on the inguinal area was the only sensation felt by the patients. CONCLUSION: The technique of penetrating the proximal stump out of the transected inguinal nerve through the external oblique aponeurosis and implanting it into the subcutan inguinal fat tissue is an effective technique to avoid neuropathic pain.