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Laparoscopic Decompression of the Pudendal Nerve

Laparoscopic Decompression of the Pudendal Nerve

We perform such an operation.

It may seem that only 4.8% of patients with chronic pelvic pain syndrome (CPPS) have a diagnosis ofPudendal Nerve Compression Neuropathy. Based on our experience, an even smaller number of them require surgery. However, when surgery is needed, the patient faces a dilemma: it turns out that very few specialists deal with this problem, and the "open" operation often proves ineffective, so neurosurgeons perform it extremely reluctantly.

Since 2014, Dr. Dilanyan's team has been addressing this issue: we perform laparoscopic decompression of the pudendal nerve.Also, in extremely severe cases, we perform laparoscopic simultaneous nerve decompression with the installation of a neuroprosthesis electrode (the so-called L.I.O.N. procedure - laparoscopic implantation of a neuroprosthesis).

What is Pudendal Neuralgia?


Usually, when discussing this problem, I ask you to imagine a person with such excruciating pain in the pelvis that simple actions like sitting, having sex, or working become impossible for them. On top of that, they face complete misunderstanding of their problems by those around them: because you simply cannot explain to your boss why you can't sit, to your partner - why sex is impossible for you, and sometimes even to the doctor why you struggle to get a prescription for any pain relief.

Comprehensive diagnostics of pudendal compression neuropathy has not yet been fully developed.

The second stage for these patients is to finally establish the diagnosis of Pudendal Compression Neuropathy, i.e., to find out that the nerve trunk is literally trapped between two ligaments. Then, they need to find a specialist who deals exclusively with this pathology and undergo a long journey of conservative treatment: from pills, physiotherapy, osteopathy to nerve block with various medications.

Many patients manage to keep their pain under control with these methods, adapting fairly well to life with pain.

Unfortunately, not everyone...

Surgery comes into play when therapy admits its helplessness.

When all possible methods of therapeutic pain correction have been exhausted, we must consider a surgical solution to the problem. Essentially, surgery for pudendal compression neuropathy involves complete excision of the ligament pressing on the nerve.

The essence of the surgery boils down to nerve decompression, i.e., the elimination of constant pressure on the nerve trunk.

The essence of the surgery:

Anatomy of the Pudendal Nerve

If we consider the anatomy of the pudendal nerve, we understand that it lies between two ligaments: the sacrospinous ligament below and the sacrotuberous ligament above.

If there is any inflammation, trauma, fibrosis, or scarring, the nerve becomes trapped: these ligaments start pressing on it. This gives rise to the well-known "tunnel syndrome" in neurosurgery.

Based on this logic, the pudendal nerve decompression surgery was devised: one of the ligaments is completely excised, and the nerve is freed.

Why is the surgery not offered to all patients?

The problem is that there are no more than a dozen surgeons worldwide who possess sufficient skill to perform such surgery.

This is due to a simple question: who should perform this operation? Ideally, neurosurgeons - after all, the nerve is being freed. However, among those who do this, urologists and gynecologists, or "pelvic surgeons," prevail. Moreover, according to preliminary data, the best results are achieved with laparoscopic surgery, for which urologists and gynecologists are trained, but not neurosurgeons.

The main problem lies in the lack of one hundred percent certainty that the surgery will help. In our own practice, with a rigorous approach to diagnostics, the effectiveness, i.e., the complete success of the operation does not exceed 83%. And this figure is actually the result of careful selection of patients to whom we offer surgery.

It should not be forgotten that pudendal nerve decompression is a desperate measure.

Key aspects of the operation:

Full Effect
89 patients out of 107 reported complete recovery
Partial Effect
12 patients reported partial regression of pain sensations
No Effect
The operation did not help 6 patients get rid of pain
Hospitalization Days
On average, the hospital stay is 5 days
By the end of 2020, we operated on 107 patients
Patients seek treatment from 27 countries

Treatment in our clinic:

1st Day:
Consultation with specialists
2nd Day:
Preparation for surgery, hospitalization
3rd Day:
Laparoscopic nerve decompression surgery
3-6 Days:
Hospital stay, treatment
1-5 Years:
Dynamic observation

During the consultation, we assess the patient's complaints according to the Nantes criteria, interpret the available test and examination data, such as the results of electroneuromyography and ultrasound of the pudendal nerves, arteries, as well as sacroiliac ligaments.

In the shortest possible time, we conduct preoperative tests and examinations to ensure the safety of the surgical intervention. This includes consultations with a cardiologist and an anesthesiologist. On the same day, the patient is hospitalized.

Day of the operation. On this day, we recommend refraining from eating and drinking in the morning. On the night before the surgery, we administer a sedative to the patient to reduce anxiety and allow for a good night's sleep. Also, preoperative antibiotic therapy is performed.

Inpatient observation and treatment involve careful monitoring of the patient's health condition, allowing us to adjust the treatment if necessary. The most important aspect at this stage is the early detection of postoperative nerve swelling and the treatment of this condition.

It is important to understand that in some cases, after the operation, careful monitoring of the patient's condition is required, sometimes requiring corrective treatment to restore the nerve.

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