Laparoscopic pudendal nerve decompression and transposition combined with omental flap protection of the nerve (Istanbul technique): technical description and feasibility analysis

Abstract

Background: We aimed in this study to investigate the efficacy of laparoscopic pudendal nerve decompression and transposition (LaPNDT) in the treatment of chronic pelvic pain due to pudendal neuralgia. Pudendal nerve entrapment (PNE) between the sacrospinous and sacrotuberous ligaments is the most frequent etiology. We describe the technical details, feasibility, and advantages of a laparoscopic approach in patients with PNE.

Methods: Consecutive patients (n = 27) with a diagnosis of PNE underwent LaPNDT with omental flap protection in an effort to prevent re-fibrosis around the nerve in the long term. The degree of pain and pain impact were evaluated pre- and postoperatively using the visual analog pain scale (VAS) and the Impact of Symptoms and Quality of Life.

Results: The mean (± standard deviation [SD]) follow-up of the 27 patients was 6.8 ± 4.2 months; 16 of the 27 were followed-up for more than 6 months. The mean (SD) operation time was 199.4 ± 36.1 (155-300) min, and the mean estimated blood loss was 39.7 ml. All patients were ambulated on the first postoperative day, and the mean (SD) hospitalization time was 2.1 ± 1.0 (1-6) days. The mean VAS scores of 27, 23, 16, and 6 patients were 1.5, 1.4, 1.6, and 2.0, postoperatively, at the first, third, sixth, and twelfth months (p < 0.0001). A more than reduction in VAS score (>80 %) was achieved in 13 of the 16 patients (81.2 %) who were followed-up for more than 6 months.

Conclusions: LaPNDT seems a feasible surgical modality for cautiously selected patients with PNE. In addition, using an omental flap for protection of the nerve is one of the most important technical advantages of laparoscopy. As a minimally invasive surgery, the laparoscopic approach can be technically feasible, with its promising preliminary results in the treatment of PNE. With further analysis, in the future it may open new frontiers for pudendal nerve neuromodulation as a new treatment modality in some intractable functional problems of the genitourinary tract.