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An international consensus algorithm for management of chronic postoperative inguinal pain

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Abstract

Purpose

Tension-free mesh repair of inguinal hernia has led to uniformly low recurrence rates. Morbidity associated with this operation is mainly related to chronic pain. No consensus guidelines exist for the management of this condition. The goal of this study is to design an expert-based algorithm for diagnostic and therapeutic management of chronic inguinal postoperative pain (CPIP).

Methods

A group of surgeons considered experts on inguinal hernia surgery was solicited to develop the algorithm. Consensus regarding each step of an algorithm proposed by the authors was sought by means of the Delphi method leading to a revised expert-based algorithm.

Results

With the input of 28 international experts, an algorithm for a stepwise approach for management of CPIP was created. 26 participants accepted the final algorithm as a consensus model. One participant could not agree with the final concept. One expert did not respond during the final phase.

Conclusion

There is a need for guidelines with regard to management of CPIP. This algorithm can serve as a guide with regard to the diagnosis, management, and treatment of these patients and improve clinical outcomes. If an expectative phase of a few months has passed without any amelioration of CPIP, a multidisciplinary approach is indicated and a pain management team should be consulted. Pharmacologic, behavioral, and interventional modalities including nerve blocks are essential. If conservative measures fail and surgery is considered, triple neurectomy, correction for recurrence with or without neurectomy, and meshoma removal if indicated should be performed. Surgeons less experienced with remedial operations for CPIP should not hesitate to refer their patients to dedicated hernia surgeons.

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Conflict of interest

None.

Author information

Authors and Affiliations

  1. Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands

    J. F. M. Lange & R. J. Ploeg

  2. Department of Surgery, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands

    R. Kaufmann & A. R. Wijsmuller

  3. Department of Surgery, Medical Center Leeuwarden, Leeuwarden, The Netherlands

    J. P. E. N. Pierie

  4. Postgraduate School of Medicine, University Groningen, Groningen, The Netherlands

    J. P. E. N. Pierie

  5. Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK

    R. J. Ploeg

  6. Department of Surgery, David Geffen School of Medicine at UCLA and Lichtenstein Amid Hernia Clinic at UCLA, Los Angeles, CA, USA

    D. C. Chen & P. K. Amid

Authors
  1. J. F. M. Lange
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  2. R. Kaufmann
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  3. A. R. Wijsmuller
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  4. J. P. E. N. Pierie
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  5. R. J. Ploeg
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  6. D. C. Chen
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  7. P. K. Amid
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Corresponding author

Correspondence to J. F. M. Lange.

Acknowledgement to the board of international experts who gave consensus

Acknowledgement to the board of international experts who gave consensus

Title

Initials

Name

Hospital

County of origin

Prof.; MD

R.

Alvarez

Director Proben Hernia Clinic, Guadalajara, Mexico

Mexico

Prof.; MD, FACS, FRCS

P.K.

Amid

Department of Surgery, Lichtenstein Amid Hernia Clinic at University of California, Los Angeles

USA

MD, FACS

M.E.

Arregui

Department of Surgery, St. Vincent Hospital, Indianapolis, Indiana

USA

MD

C.R.

Berney

Department of Surgery, Bankstown-Lidcombe Hospital, University of New South Wales, Bankstown

Australia

MD

F.

Berrevoet

Department of Surgery, University Hospital Ghent

Belgium

Prof.; MD, PhD

G.

Campanelli

Department of Surgery, University of Insubria, Varese

Italy

MD, FACS

D.C.

Chen

Department of Surgery, Lichtenstein Amid Hernia Clinic at University of California, Los Angeles

USA

Prof.; MD, FACS

R.J.

Fitzgibbons Jr.

Department of Surgery Creighton University School of Medicine, Omaha, Nebraska

USA

MD, PhD

D.

Van Geldere

Department of Surgery, Isala Klinieken, Zwolle

Netherlands

MD

C.

De Gheldere

Department of Surgery, Heilige Hart Kliniek, Lier

Belgium

MD

H.

Van Goor

Department of Surgery, Radboud University Nijmegen Medical Center

Netherlands

Prof.; MD, PhD

J.

Jeekel

Department of Neuroscience, Erasmus Medical Centre, Rotterdam

Netherlands

MD

A.N.

Kingsnorth

Department of Surgery, Derriford Hospital, Plymouth

UK

MD

J.F.M.

Lange Jr.

University Medical Center Groningen

Netherlands

Prof.; MD, PhD

J.F.

Lange Sr.

Department of Surgery, Erasmus Medical Centre, Rotterdam

Netherlands

Prof.; MD, PhD

M.

Miserez

Department of Abdominal Surgery, Universitair Ziekenhuis, Leuven

Belgium

MD, PhD

O.

Mjaland

Department of Surgery, SSHF Kristiansand

Norway

MD, PhD

A.

Montgomery

Department of Surgery, University Hospital, Malmö

Sweden

MD

S.

Morales-Conde

Unit of Innovation in Minimally Invasive Surgery, University Hospital Virgen del Roco, Seville

Spain

MD

F.E.

Muysoms

Department of General Surgery, AZ Maria Middelares, Ghent

Belgium

MD

E.P.

Pelissier

Department of Digestive Pathology, Institut Montsouris, Paris

France

MD

W.M.

Reinpold

Department of Surgery, Krankenhaus Reinbek St. Adolf-Stift, Reinbek

Germany

MD

M.P.

Simons

Department of Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam

Netherlands

MD

R.K.J.

Simmermacher

Department of Surgery, University Hospital, Utrecht

Netherlands

MD

F.

Ugahary

Retired

Netherlands

MD, PhD

A.R.

Wijsmuller

Department of Surgery, Erasmus Medical Centre, Rotterdam

Netherlands

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Lange, J.F.M., Kaufmann, R., Wijsmuller, A.R. et al. An international consensus algorithm for management of chronic postoperative inguinal pain. Hernia 19, 33–43 (2015). https://doi.org/10.1007/s10029-014-1292-y

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  • DOI: https://doi.org/10.1007/s10029-014-1292-y

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