TY - JOUR
T1 - Intercostal neuroma pain after laparoscopic cholecystectomy
T2 - Diagnosis and treatment
AU - Dellon, A. Lee
N1 - Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2014/3
Y1 - 2014/3
N2 - Background: Chest wall or abdominal pain after laparoscopic cholecystectomy is perceived as residual gastrointestinal problems. Some patients will have tenderness at the laparoscopic portal site(s), representing injury to one or more intercostal nerves. The author describes this patient population for the first time, outlining a diagnostic and therapeutic algorithm. Methods: Inclusion criteria included (1) right chest wall or abdominal pain persisting more than 1 year after laparoscopic cholecystectomy, (2) relief of that pain with intercostal nerve block, (3) resection of intercostal nerves identified by nerve block, and (4) at least a 6-month postoperative follow-up by telephone. Review from 2009 through 2011 identified one man and seven women meeting these criteria. Mean age was 44 years (range, 18 to 74 years). Mean interval between cholecystectomy and intercostal neurectomy was 44.3 months (range, 13 to 72 months). Results: Two intercostal nerves were resected in two patients, three in four patients, four in one patient, and five in one patient, most commonly intercostal nerves T6, T7, and T8. Proximal nerves were implanted into the serratus or latissimus dorsi. At a mean period of 18.3 months after surgery, the preoperative mean visual analogue score of 8.9 (range, 7 to 10) decreased to 3.6 (range, 0 to 6) (p < 0.01). Overall results were excellent in five (63 percent) and good in two (25 percent), with one failure (12 percent). Conclusions: Pain following laparoscopic cholecystectomy may represent intercostal nerve injury. Diagnostic blocks are essential to confirm diagnosis. Nerve resection and implantation of the proximal ends into muscle can give good to excellent results in most patients.
AB - Background: Chest wall or abdominal pain after laparoscopic cholecystectomy is perceived as residual gastrointestinal problems. Some patients will have tenderness at the laparoscopic portal site(s), representing injury to one or more intercostal nerves. The author describes this patient population for the first time, outlining a diagnostic and therapeutic algorithm. Methods: Inclusion criteria included (1) right chest wall or abdominal pain persisting more than 1 year after laparoscopic cholecystectomy, (2) relief of that pain with intercostal nerve block, (3) resection of intercostal nerves identified by nerve block, and (4) at least a 6-month postoperative follow-up by telephone. Review from 2009 through 2011 identified one man and seven women meeting these criteria. Mean age was 44 years (range, 18 to 74 years). Mean interval between cholecystectomy and intercostal neurectomy was 44.3 months (range, 13 to 72 months). Results: Two intercostal nerves were resected in two patients, three in four patients, four in one patient, and five in one patient, most commonly intercostal nerves T6, T7, and T8. Proximal nerves were implanted into the serratus or latissimus dorsi. At a mean period of 18.3 months after surgery, the preoperative mean visual analogue score of 8.9 (range, 7 to 10) decreased to 3.6 (range, 0 to 6) (p < 0.01). Overall results were excellent in five (63 percent) and good in two (25 percent), with one failure (12 percent). Conclusions: Pain following laparoscopic cholecystectomy may represent intercostal nerve injury. Diagnostic blocks are essential to confirm diagnosis. Nerve resection and implantation of the proximal ends into muscle can give good to excellent results in most patients.
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M3 - Article
C2 - 24572861
AN - SCOPUS:84897792366
SN - 0032-1052
VL - 133
SP - 718
EP - 721
JO - Plastic and reconstructive surgery
JF - Plastic and reconstructive surgery
IS - 3
ER -