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Invited Critique
January 2002

A 1-Stage Surgical Treatment for Postherniorrhaphy Neuropathic Pain—Invited Critique

Arch Surg. 2002;137(1):104. doi:10.1001/archsurg.137.1.104

Interest in postherniorrhaphy groin pain has escalated in recent years. This discomfort is not postoperative wound pain of short duration, but rather neuralgia that persists for months or even years following various types of operative dissection.

Amid has returned to this subject after 13 years1 and now urges us to ablate in 1 operation all 3 sensory nerves (ilioinguinal, iliohypogastric, and genital branch of the genitofemoral) from the inguinal anterior approach to ensure that all pathological moieties are removed. This contradicts the position of Starling2 who fully agrees with the anterior inguinal approach to the ilioinguinal and iliohypogastric nerves but, because of the difficulty in exposing and dissecting the genital branch anteriorly, prefers the lumbar approach in a second operation, if necessary.