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Prevention and Evaluation of Chronic Groin Pain

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Textbook of Hernia

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Abstract

In this chapter authors review risk factors for postoperative chronic pain and provide some suggestion in order to prevent it.

First of all it is import to select the patient for groin hernia repair: patients with unusual preoperative inguinal pain in an imperceptible hernia must be evaluated with attention and often a proper physical examination and clinical history investigation reveal a different cause for their pain. Among all pathologies that can cause inguinodynia, the so-called pubic inguinal pain syndrome (PIPS) or sportsman hernia is often wrongly labeled inguinal hernia and treat like it were, with terrible and painful consequences.

There is not significant difference for chronic postoperative pain in lap or open approach, but TAPP surgery can be recommended for those patients that, according to preoperative data on Activity Assessment Scale score and response to heat stimulation, are considered to be at high risk for persisting postoperative pain.

Identification and protection of all three inguinal nerves, avoid removing the nerves from their natural bed as much as possible, and removing their covering fascia are essential tricks to prevent chronic pain.

Atraumatic mesh fixation can have a beneficial effect in open and in selected patient in lap approach.

Social, genetic, patient, and psychological factors increase the complexity of diagnosis; for these reasons, evaluation of the patient should always include neurophysiological assessment, preoperative characteristics (nociceptive functions, psychosocial factors, pain in other parts of the body), and the subministration of a validated inguinal hernia repair specific questionnaires.

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Authors and Affiliations

  1. University of Insubria, Istituto Clinico Sant’Ambrogio, Center of Research and High Specialization for the Pathologies of Abdominal Wall and Surgical Treatment and Repair of Abdominal Hernia, Milano, Italy

    Giampiero Campanelli M.D., Marta Cavalli M.D., Ph.D., Piero Giovanni Bruni & Andrea Morlacchi

Authors
  1. Giampiero Campanelli M.D.
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  2. Marta Cavalli M.D., Ph.D.
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  3. Piero Giovanni Bruni
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  4. Andrea Morlacchi
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Correspondence to Giampiero Campanelli M.D. .

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Editors and Affiliations

  1. Department of Surgery, New Hanover Regional Medical Center, Wilmington, North Carolina, USA

    William W. Hope

  2. USC School of Medicine-Greenville, Greenville Health System, Greenville, North Carolina, USA

    William S. Cobb

  3. Johns Hopkins Hospital, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA

    Gina L. Adrales

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Campanelli, G., Cavalli, M., Bruni, P.G., Morlacchi, A. (2017). Prevention and Evaluation of Chronic Groin Pain. In: Hope, W., Cobb, W., Adrales, G. (eds) Textbook of Hernia. Springer, Cham. https://doi.org/10.1007/978-3-319-43045-4_18

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  • DOI: https://doi.org/10.1007/978-3-319-43045-4_18

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