Obturator neuralgia: treatment and preliminary results of laparoscopic neurolysis

Obturator neuralgia is a pain which is ill-defined and particularly less well-known to practitioners. Here we report on the etiologies, the treatment and the results of conservative laparoscopic treatment by neurolysis of the obturator nerve in cases of obturator neuralgia. Thirteen patients (15 nerves) who had obturator neuralgia have been treated in our service since 2005. The etiologies were idiopathic (four cases), following surgery for an inguinal hernia (two cases), trauma of the pelvis (one case), a TVT strip (three cases) and a TOT strip (three cases). The diagnosis was based on the pain, which was neuropathic, of the antero-internal side of the thigh. It was confirmed under block anesthetic by tomodensitometry using a posterior approach. The treatment consisted of laparoscopic neurolysis. The patients suffered pain measured at a rate of 8/10 on the visual analogical scale before the operation. In each case, neurolysis was carried out by transperitoneal laparoscopy by dissecting the nerve and sectionning the scarring fibrosis where the prothesis was in contact. In the idiopathic cases, the liberation of the nerve was carried out by a section of the internal obturator muscle and of the obtured membrane, allowing for the blocked canal to be widened. Seventeen months later, a rate of improvement of at least 50% of pain was found in 77% of cases (10/13), of whom pain had totally disappeared in 54% of cases (7/13). There was no improvement at all for 23% of cases (3/13). The mini-invasive conservative treatment of obturator neuralgia by laparascopic neurolysis of the obturator nerve, after confirmed diagnosis by selective infiltration allowed for a rate of 75% of improvement to be obtained after a period of 17 months.