The question of the superior operative technique for meralgia paresthetica is unsettled. Operative treatment by either neurolysis or transection of the lateral femoral cutaneous nerve was performed in 21 patients with meralgia paresthetica after complete failure of conservative treatment; neurolysis in 10 patients and transection in 11 patients were performed by five neurosurgeons. The average follow-up period was 74 months (+/- 52 mo). The results were scored as complete relief, partial relief, or failure. Direct comparison of neurolysis and transection confirmed the superiority of transection as a treatment for meralgia paresthetica (Mann-Whitney-U test, P = 0.022; one-sample sign test, P = 0.0020).