Copyright © 2016 American Society of Plastic Surgeons. Unauthorized reproduction of this article is prohibited. www.PRSJournal.com 204 O pen and laparoscopic abdominal, trunk, and pelvic operations are very com- monly performed procedures in the United States. In 2006, U.S. ambulatory sur- gery centers performed approximately 920,000 hernia repairs (of which 526,000 were inguinal hernias) and 500,000 laparoscopic cholecys- tectomies. 1 A Cochrane meta-analysis of lapa- roscopic versus open inguinal hernia repairs found a low recurrence rate (3 percent) but a high incidence of chronic pain (14 to 19 per- cent). 2 Other studies have found the incidence of chronic groin pain after hernia repair to be anywhere between 6 and 36 percent. 3–6 Similarly, other trunk operations such as cesarean deliv- ery, laparoscopic cholecystectomy, thoracot- omy, and sternotomy have also been found to have high incidences of chronic postopera- tive pain (range, 18 to 26 percent). 7 As such, a large number of patients exist that suffer from chronic postoperative neurogenic pain. Disclosure: The authors have no relevant financial conflicts of interest to disclose. No external funding was received. Copyright © 2016 by the American Society of Plastic Surgeons DOI: 10.1097/PRS.0000000000002892 Purushottam Nagarkar, M.D. Smita Ramanadham, M.D. Khalil Chamseddin, M.D. Avneesh Chhabra, M.D. Shai M. Rozen, M.D. Dallas, Texas Background: Incidence of chronic postoperative neurogenic pain after open and laparoscopic trunk operations is reported between 1 and 20 percent, ren- dering a large population in the United States and worldwide. One possible treatment is selective surgical neurectomy. Methods: All patients who underwent neurectomy for chronic trunk or groin postoperative neurogenic pain were identified. Based on individual history and examination, patients underwent neurectomies of the ilioinguinal, ilio- hypogastric, genitofemoral, lateral-femoral cutaneous, or intercostal nerves. Recorded preoperative pain levels (Likert score ranging from 0 to 10) were compared to postoperative pain levels and quality-of-life indices were assessed. Results: Fifty-six patients (32 men and 24 women) were included. Mean age was 49 years. All patients underwent preoperative nerve blocks by either sur- geon, radiologist, or referring physician, and had either complete or significant response defined as over 50 percent relief. Forty-five patients completed the survey. Median follow-up was 2.8 years (range, 1.0 to 5.7 years). Average pain level was 9.0 preoperatively and 3.5 postoperatively. Quality-of-life impairment improved from 8.3 preoperatively to 3.5 postoperatively. A subset of patients (n = 12) had minimal improvement, reporting a decrease in pain from 8.5 to 7.2 and quality-of-life improvement from 8.5 to 7.1. Conclusions: Complete avoidance of nerve injury during all trunk and groin operations is likely unattainable. When chronic postoperative neurogenic pain develops, neurectomy can be an effective means of treatment, significantly improving pain and quality of life in most patients. Better insight is necessary into a patient subset responding to nerve blocks yet experiencing minimal postoperative improvement. (Plast. Reconstr. Surg. 139: 204, 2017.) CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV. From the Departments of Plastic Surgery and Radiology, University of Texas Southwestern Medical Center. Received for publication January 6, 2016; accepted August 11, 2016. Neurectomy for the Treatment of Chronic Postoperative Pain after Surgery of the Trunk Supplemental digital content is available for this article. A direct URL citation appears in the text; simply type the URL address into any Web browser to access this content. A clickable link to the material is provided in the HTML text of this article on the Journal’s website (www.PRSJournal.com). RECONSTRUCTIVE