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Algorithmic Approach to the Workup and Management of Chronic Postoperative Inguinal Pain

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The SAGES Manual of Groin Pain

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Abstract

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. A group of surgeons considered experts on inguinal hernia surgery was solicited to develop the algorithm. 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 chronic postoperative inguinal pain (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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Acknowledgements

Special thanks to the following colleagues involved in the emergence of this algorithm:

M.E. Arregui, C.R. Berney, F. Berrevoet, G. Campanelli, D.C. Chen, R.J. Fitzgibbons Jr., D. van Geldere, C. de Gheldere, H. van Goor, J. Jeekel, A.N. Kingsnorth, J.F. Lange Sr., R. Kauffman, M. Miserez, O. Mjaland, A. Montgommery, S. Morales-Conde, F.E. Muysoms, E.P. Pellisier, J.P.E.N. Pierie, R.J. Ploeg, W.M. Reinpold, M.P. Simons, R.K.J. Simmermacher, F. Ugahary, A.R. Wijsmuller

This chapter is based on an article published in Hernia (Lange JF, Kaufmann R, Wijsmuller AR, Pierie JP, Ploeg RJ, Chen DC, Amid PK. An international consensus algorithm for management of chronic postoperative inguinal pain. Hernia. 2015;19(1):33–43), with the kind permission of the editor and Springer Science + Business Media.

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Authors and Affiliations

  1. Department of Surgery, The University Medical Center Groningen, Hanzeplein 1, 9700 RB, Groningen, Netherlands

    Johan F. M. Lange Jr. MD

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  1. Johan F. M. Lange Jr. MD
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Correspondence to Johan F. M. Lange Jr. MD .

Editor information

Editors and Affiliations

  1. Mount Sinai School of Medicine, Laparoscopic Surgical Center of New York, New York, New York, USA

    Brian P. Jacob

  2. Division of General Surgery, Lichtenstein Amid Hernia Clinic at UCLA, Santa Monica, California, USA

    David C. Chen

  3. FSU College of Medicine, Advanced Hernia Solutions, Daytona Beach, Florida, USA

    Bruce Ramshaw

  4. Beverly Hills Hernia Center, Beverly Hills, California, USA

    Shirin Towfigh

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© 2016 Springer International Publishing Switzerland

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Lange, J.F.M. (2016). Algorithmic Approach to the Workup and Management of Chronic Postoperative Inguinal Pain. In: Jacob, B., Chen, D., Ramshaw, B., Towfigh, S. (eds) The SAGES Manual of Groin Pain. Springer, Cham. https://doi.org/10.1007/978-3-319-21587-7_18

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  • DOI: https://doi.org/10.1007/978-3-319-21587-7_18

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-21586-0

  • Online ISBN: 978-3-319-21587-7

  • eBook Packages: MedicineMedicine (R0)

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