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The SAGES Manual of Hernia Surgery pp 533–548Cite as

Chronic Pain After Inguinal Repair

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Abstract

Chronic pain after inguinal hernia repair remains one of the most challenging problems for patients and hernia surgeon alike. Affecting up to 10% of patients, chronic pain can lead to significant disability and affect the patient’s daily activities and ability to work. This chapter will review the complex anatomy and pathophysiology of chronic pain after inguinal hernia repair. It will detail the diagnosis of patients presenting with chronic pain as well as outline the multimodal approach to treatment strategies. Finally, we will review our operative strategy for patients that may benefit from neurectomy to treat this difficult problem.

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References

  1. Bay-Nielsen M, Thomsen H, Andersen FH, et al. Convalescence after inguinal herniorrhaphy. Br J Surg. 2004;91(3):362–7.

    Article  CAS  Google Scholar 

  2. Bittner R, Schwarz J. Inguinal hernia repair: current surgical techniques. Langenbecks Arch Surg. 2012;397(2):271–82.

    Article  CAS  Google Scholar 

  3. Macrae WA, HTO D. Chronic postsurgical pain. In: Crombie IK, Linton S, Croft P, Von Korff M, LeResche L, editors. Epidemiology of pain. Seattle: IASP Press; 1999. p. 125–42.

    Google Scholar 

  4. Nienhuijs S, Staal E, Strobbe L, Rosman C, Groenewoud H, Bleichrodt R. Chronic pain after mesh repair of inguinal hernia: a systematic review. Am J Surg. 2007;194(3):394–400.

    Article  Google Scholar 

  5. Aasvang E, Kehlet H. Chronic postoperative pain: the case of inguinal herniorrhaphy. Br J Anaesth. 2005;95(1):69–76.

    Article  CAS  Google Scholar 

  6. Alfieri S, Amid PK, Campanelli G, et al. International guidelines for prevention and management of post-operative chronic pain following inguinal hernia surgery. Hernia. 2011;15(3):239–49.

    Article  CAS  Google Scholar 

  7. Poobalan AS, Bruce J, Smith WC, King PM, Krukowski ZH, Chambers WA. A review of chronic pain after inguinal herniorrhaphy. Clin J Pain. 2003;19(1):48–54.

    Article  Google Scholar 

  8. Cunningham J, Temple WJ, Mitchell P, Nixon JA, Preshaw RM, Hagen NA. Cooperative hernia study. Pain in the postrepair patient. Ann Surg. 1996;224(5):598–602.

    Article  CAS  Google Scholar 

  9. Hakeem A, Shanmugam V. Current trends in the diagnosis and management of post-herniorraphy chronic groin pain. World J Gastrointest Surg. 2011;3(6):73–81.

    Article  Google Scholar 

  10. Kehlet H, Jensen TS, Woolf CJ. Persistent postsurgical pain: risk factors and prevention. Lancet. 2006;367(9522):1618–25.

    Article  Google Scholar 

  11. Kalliomaki ML, Meyerson J, Gunnarsson U, Gordh T, Sandblom G. Long-term pain after inguinal hernia repair in a population-based cohort; risk factors and interference with daily activities. Eur J Pain. 2008;12(2):214–25.

    Article  Google Scholar 

  12. Werner MU, Mjobo HN, Nielsen PR, Rudin A. Prediction of postoperative pain: a systematic review of predictive experimental pain studies. Anesthesiology. 2010;112(6):1494–502.

    Article  Google Scholar 

  13. Hinrichs-Rocker A, Schulz K, Jarvinen I, Lefering R, Simanski C, Neugebauer EA. Psychosocial predictors and correlates for chronic post-surgical pain (CPSP)–a systematic review. Eur J Pain. 2009;13(7):719–30.

    Article  Google Scholar 

  14. Sajid MS, Kalra L, Parampalli U, Sains PS, Baig MK. A systematic review and meta-analysis evaluating the effectiveness of lightweight mesh against heavyweight mesh in influencing the incidence of chronic groin pain following laparoscopic inguinal hernia repair. Am J Surg. 2013;205(6):726–36.

    Article  Google Scholar 

  15. de Goede B, Klitsie PJ, van Kempen BJ, et al. Meta-analysis of glue versus sutured mesh fixation for Lichtenstein inguinal hernia repair. Br J Surg. 2013;100(6):735–42.

    Article  Google Scholar 

  16. Zhang C, Li F, Zhang H, Zhong W, Shi D, Zhao Y. Self-gripping versus sutured mesh for inguinal hernia repair: a systematic review and meta-analysis of current literature. J Surg Res. 2013;185(2):653–60.

    Article  Google Scholar 

  17. Nordin P, Zetterstrom H, Gunnarsson U, Nilsson E. Local, regional, or general anaesthesia in groin hernia repair: multicentre randomised trial. Lancet. 2003;362(9387):853–8.

    Article  Google Scholar 

  18. Kehlet H, Aasvang E. Groin hernia repair: anesthesia. World J Surg. 2005;29(8):1058–61.

    Article  Google Scholar 

  19. Franneby U, Sandblom G, Nordin P, Nyren O, Gunnarsson U. Risk factors for long-term pain after hernia surgery. Ann Surg. 2006;244(2):212–9.

    Article  Google Scholar 

  20. Rab M, Ebmer, Dellon AL. Anatomic variability of the ilioinguinal and genitofemoral nerve: implications for the treatment of groin pain. Plast Reconstr Surg. 2001;108(6):1618–23.

    Article  CAS  Google Scholar 

  21. Amid PK, Hiatt JR. New understanding of the causes and surgical treatment of postherniorrhaphy inguinodynia and orchalgia. J Am Coll Surg. 2007;205(2):381–5.

    Article  Google Scholar 

  22. Harms BA, DeHaas DR Jr, Starling JR. Diagnosis and management of genitofemoral neuralgia. Arch Surg. 1984;119(3):339–41.

    Article  CAS  Google Scholar 

  23. Starling JR, Harms BA. Diagnosis and treatment of genitofemoral and ilioinguinal neuralgia. World J Surg. 1989;13(5):586–91.

    Article  CAS  Google Scholar 

  24. Bradley M, Morgan D, Pentlow B, Roe A. The groin hernia–an ultrasound diagnosis? Ann R Coll Surg Engl. 2003;85(3):178–80.

    Article  Google Scholar 

  25. Ferzli GS, Edwards ED, Khoury GE. Chronic pain after inguinal herniorrhaphy. J Am Coll Surg. 2007;205(2):333–41.

    Article  Google Scholar 

  26. Aasvang EK, Jensen KE, Fiirgaard B, Kehlet H. MRI and pathology in persistent postherniotomy pain. J Am Coll Surg. 2009;208(6):1023–8, discussion 1028–9.

    Article  Google Scholar 

  27. Knockaert DC, Boonen AL, Bruyninckx FL, Bobbaers HJ. Electromyographic findings in ilioinguinal-iliohypogastric nerve entrapment syndrome. Acta Clin Belg. 1996;51(3):156–60.

    Article  CAS  Google Scholar 

  28. Ellis RB, Geisse H, Holub BA, et al. Ilioinguinal nerve conduction. Muscle Nerve. 1992;15:1195.

    Google Scholar 

  29. Filler A. Magnetic resonance neurography and diffusion tensor imaging: origins, history, and clinical impact of the first 50,000 cases with an assessment of efficacy and utility in a prospective 5000-patient study group. Neurosurgery. 2009;65(4 Suppl):A29–43.

    Article  Google Scholar 

  30. Bushnell MC, Ceko M, Low LA. Cognitive and emotional control of pain and its disruption in chronic pain. Nat Rev Neurosci. 2013;14(7):502–11.

    Article  CAS  Google Scholar 

  31. Garnock-Jones KP, Keating GM. Lidocaine 5% medicated plaster: a review of its use in postherpetic neuralgia. Drugs. 2009;69(15):2149–65.

    Article  CAS  Google Scholar 

  32. Bischoff JM, Petersen M, Uceyler N, Sommer C, Kehlet H, Werner MU. Lidocaine patch (5%) in treatment of persistent inguinal postherniorrhaphy pain: a randomized, double-blind, placebo-controlled, crossover trial. Anesthesiology. 2013;119(6):1444–52.

    Article  CAS  Google Scholar 

  33. Derry S, Sven-Rice A, Cole P, Tan T, Moore RA. Topical capsaicin (high concentration) for chronic neuropathic pain in adults. Cochrane Database Syst Rev. 2013;(2):CD007393. https://doi.org/10.1002/14651858.CD007393.

  34. Mick G, Correa-Illanes G. Topical pain management with the 5% lidocaine medicated plaster—a review. Curr Med Res Opin. 2012;28(6):937–51.

    Article  CAS  Google Scholar 

  35. Bjurstrom MF, Nicol AL, Amid PK, Chen DC. Pain control following inguinal herniorrhaphy: current perspectives. J Pain Res. 2014;7:277–90.

    PubMed  PubMed Central  Google Scholar 

  36. Aasvang E, Kehlet H. Surgical management of chronic pain after inguinal hernia repair. Br J Surg. 2005;92(7):795–801.

    Article  CAS  Google Scholar 

  37. Moore AM, Bjurstrom MF, Hiatt JR, Amid PK, Chen DC. Efficacy of retroperitoneal triple neurectomy for refractory neuropathic inguinodynia. Am J Surg. 2016;212:1126–32.

    Article  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Surgery, Kaiser Permanente Northern California, Oakland, CA, USA

    David K. Nguyen

  2. Section of Minimally Invasive Surgery, UCLA Division of General Surgery, Lichtenstein Amid Hernia Clinic at UCLA, Los Angeles, CA, USA

    David C. Chen

Authors
  1. David K. Nguyen
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  2. David C. Chen
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Corresponding author

Correspondence to David C. Chen .

Editor information

Editors and Affiliations

  1. Emory University, Atlanta, GA, USA

    S. Scott Davis, Jr.

  2. Weill Med College At Cornell University, New York, NY, USA

    Gregory Dakin

  3. Stony Brook Surgical Associates, Centereach, NY, USA

    Andrew Bates

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© 2019 Society of American Gastrointestinal and Endoscopic Surgeons (SAGES)

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Nguyen, D.K., Chen, D.C. (2019). Chronic Pain After Inguinal Repair. In: Davis, Jr., S., Dakin, G., Bates, A. (eds) The SAGES Manual of Hernia Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-78411-3_39

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  • DOI: https://doi.org/10.1007/978-3-319-78411-3_39

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-78410-6

  • Online ISBN: 978-3-319-78411-3

  • eBook Packages: MedicineMedicine (R0)

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