Name of the Procedure:

Revision or Removal of Peripheral or Gastric Neurostimulator Pulse Generator or Receiver

Summary

This procedure involves either modifying or completely removing the pulse generator or receiver of a neurostimulator device placed in the peripheral nerves or the stomach. These devices are used to manage chronic pain or gastrointestinal issues by sending electrical impulses to specific nerves or tissues.

Purpose

The procedure addresses issues arising from a malfunctioning or ineffective neurostimulator device. The goals are to re-establish the device's functionality (in case of revision) or to eliminate any adverse effects caused by the device (in case of removal).

Indications

• Pain unrelieved by the current neurostimulator settings.
• Device malfunction or failure.
• Infection at the implant site.
• Unwanted side effects from the device.
• Changes in the medical condition making the device unnecessary.

Preparation

• Fasting for at least 6 hours before the procedure.
• Adjustments in medication as advised by the healthcare provider.
• Pre-procedural imaging scans (e.g., X-ray, MRI) to assess the device and surrounding tissues.

Procedure Description

1. The patient is positioned in a sterile environment.
2. Anesthesia or sedation is administered, typically local anesthesia or general anesthesia.
3. An incision is made over the site of the neurostimulator device.
4. For revision, the pulse generator or receiver is adjusted or replaced.
5. For removal, the device and connecting leads are carefully extracted.
6. The incision is then closed with sutures.
7. The site is cleaned and dressed appropriately.

Duration

The procedure typically takes 1 to 2 hours, depending on the complexity.

Setting

Performed in a hospital or a surgical center, usually on an outpatient basis.

Personnel

• Surgeon specialized in neurostimulator procedures.
• Surgical nurses.
• Anesthesiologist, if general anesthesia is used.

Risks and Complications

• Infection.
• Bleeding or hematoma at the incision site.
• Pain or discomfort.
• Damage to surrounding tissues or nerves.
• Incomplete removal of the device (for removal procedures).
• Need for additional surgery if issues persist.

Benefits

• Relief from pain or complications related to a malfunctioning device.
• Improved quality of life by restoring the device’s functionality (for revisions).
• Elimination of adverse effects from the device (for removals).
• Benefits can be immediate or develop over several days.

Recovery

• Post-procedure monitoring for a few hours to ensure stability.
• Pain management with prescribed medications.
• Instructions on incision care and activity restrictions.
• Follow-up appointments for wound assessment and, if needed, reprogramming of a revised device.
• Recovery time varies; generally, most patients resume normal activities within 1-2 weeks.

Alternatives

• Pharmacologic management of pain or gastrointestinal issues.
• Physical therapy or counseling for pain management.
• Other surgical interventions.
• Pros and cons of each alternative depend on individual patient health, efficacy, and side effects.

Patient Experience

• Mild to moderate pain or discomfort at the incision site following the procedure.
• Sensations of stiffness or soreness as the incision heals.
• Any significant pain or unusual symptoms should be reported to the healthcare provider.
• Pain management includes prescribed medication and comfort measures such as ice packs and rest.