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A minimally invasive, endoscopic transgluteal procedure for pudendal nerve and inferior cluneal nerve neurolysis in case of entrapment: 3- and 6-month results. The ENTRAMI technique for neurolysis

par Jottard, Katleen;Bruyninx, Luc ;Bonnet, Pierre;De Wachter, Stefan
Référence International journal of colorectal disease, 35, 2, page (361-364)
Publication Publié, 2020-02

Article révisé par les pairs

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Résumé :

Background: Pudendal and cluneal nerve entrapment can cause a neuropathic pain syndrome in the sensitive areas innervated by these nerves. Recently, a new endoscopic minimal invasive approach for pudendal and inferior cluneal nerve neurolysis has been published in a cadaver study. The aim of our study was to describe the feasibility of this new approach and to evaluate the clinical outcome. Methods: Fifteen patients underwent the ENTRAMI technique. The Numeric Pain Rating Scale (NPRS) and Patient Global Impression of Change (PGIC) were recorded at baseline and at 3 and 6 months after surgery. Result: The average duration of intervention (skin to skin) was 139 min (range 50–270 min) for bilateral pudendal neurolysis and/or cluneal neurolysis and 113 min (range 100–130 min) for unilateral pudendal and/or cluneal neurolysis. No perioperative blood loss occurred. At 3 months, 50% of patients declared a more than 30% improvement of their PGIC, increasing to 57% at 6 months; 31% reported more than 90% improvement of PGIC at 6 months. Overall reduction of the average maximal NPRS score was from 9 (range 7–10) to 6 at 3 months (range 0–10; p value < 0.05) and to 5 at 6 months (range 0–10; p value < 0.05). There were no postoperative complications. Conclusions: The ENTRAMI technique is feasibly in patients suffering from pudendal and/or cluneal neuralgia and preliminary results are promising. Clinical trial number:: NCT03883178.