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Intraneural fibrosis within ilioinguinal nerve in inguinal hernia patients with preoperative pain: it’s the sign of irreversible nerve injury, isn’t it?

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Abstract

Purpose

Preoperative pain is known as one of the most powerful risk factors for chronic postoperative inguinal pain (CPIP), while its pathogenesis has not been fully elucidated. The aim of the present study was to evaluate patients with preoperative pain from the pathological perspective and discuss the potential pathogenesis of CPIP in those patients.

Methods

This was a single-institutional retrospective study. The study population was inguinal hernia patients with preoperative pain who underwent open anterior hernia repair for primary inguinal hernia with pragmatic ilioinguinal neurectomy during surgery between March 2021 and March 2023. The primary and secondary outcomes were proportion of collagen deposition and mucus accumulation within ilioinguinal nerve in those patients, respectively, which were evaluated histologically using Image J software.

Results

Forty patients were evaluated. Median value of proportion of intraneural collagen deposition was 38.3% (27.7–95.9). These values were positively correlated with the duration of pain (r2=0.468, P<0.001). Median value of proportion of mucus accumulation in ilioinguinal nerve was 50.1% (0–82.0). These values had no correlation with any clinicopathological variables.

Conclusions

In the present study population, all patients with preoperative pain had intraneural fibrosis within ilioinguinal nerve, and its degree had a positive correlation with the pain duration.

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Data Availability

All data in the present study are fully available without restriction. The data underlying the findings of this study are either available in the manuscript or upon request from the corresponding author, Masato Narita.

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Authors and Affiliations

  1. Department of Surgery, Kyoto Medical Center, 1-1 Fukakusamukaihata-cho, Fushimi-ku, Kyoto, 6128555, Japan

    Masato Narita, Ryoya Yamaoka, Masaaki Moriyama, Kanako Degawa, Masashi Fushitani, Hiroya Kojima, Takahiro Suenaga, Hiroki Nakanishi, Gen Nishikawa, Yasutaka Nakanishi & Hiroaki Hata

  2. Department of Surgery, Kobe City Medical Center General Hospital, Kobe City, Japan

    Masato Narita

  3. Department of Diagnostic Pathology, Kyoto Medical Center, 1-1 Fukakusamukaihata-cho, Fushimi-ku, Kyoto, 6128555, Japan

    Koki Moriyoshi

Authors
  1. Masato Narita
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  2. Koki Moriyoshi
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Contributions

MN, R.Y., MM, KD, MF, HK, and TS collected and analyzed the data. MN wrote the main manuscript. KM performed pathological assessment and prepared figures. HN, GN, YN, and HH made a critical appraisal and reviewed the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Masato Narita.

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Narita, M., Moriyoshi, K., Yamaoka, R. et al. Intraneural fibrosis within ilioinguinal nerve in inguinal hernia patients with preoperative pain: it’s the sign of irreversible nerve injury, isn’t it?. Langenbecks Arch Surg 408, 431 (2023). https://doi.org/10.1007/s00423-023-03158-y

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