Surgical management of leprosy-associated neuropathy in Pakistan: Restoring function and reducing disability in the post-elimination era: A narrative review

Abstract

Objectives: To narratively review the role of surgical interventions in the management of leprosy-associated neuropathy in Pakistan, focusing clinical indications, timing, and outcomes of nerve decompression, nerve abscess management, and reconstructive procedures. This review also aimed to highlight gaps in local evidence, compare Pakistani practices with global standards, and assess how surgical care can be integrated into national leprosy control efforts to reduce disability in the post-elimination era.

Methodology: Literature search was conducted (PubMed, Embase, Cochrane; 1980–2025) to provide a broad overview of the epidemiology, medical management, rehabilitation, and surgical treatment of leprosy-associated neuropathy. Studies describing surgical indications, techniques, outcomes, or rehabilitation were emphasized. Publications focused exclusively on medical therapy without neurological outcomes were excluded. Pakistani studies were prioritized, while international literature was included to contextualize local practice and supplement limited national data.

Results: Surgical services in Pakistan are largely limited to specialized centres such as MALC and AKUH. Nerve decompression, tendon transfers, and reconstructive procedures have the potential to restore function and prevent ulcers, with functional recovery rates in comparable low-resource settings. Early surgical intervention combined with rehabilitation yields the best outcomes in most of the articles. International models demonstrate that integration of surgical care into national programs is feasible and effective, even in resource-constrained environments.

Conclusion: The reviewed evidence indicates that surgical intervention with rehabilitation offers optimal outcomes for leprosy-associated neuropathy. In Pakistan’s post-elimination era, prioritizing disability prevention through expansion of surgical services, strengthening reconstructive training, and integrating rehabilitation into national leprosy programs is essential to reducing long-term disability and stigma.