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Mesh Removal and Selective Neurectomy for Persistent Groin Pain Following Lichtenstein Repair

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Abstract

Background

Some patients with persistent inguinodynia following a Lichtenstein hernia repair fail all non-surgical treatments. Characteristics of mesh-related pain are not well described whereas a meshectomy is controversial. Aims were to define mesh-related pain symptoms, to investigate long-term effects of a meshectomy and to provide recommendations on meshectomy.

Methods

Consecutive patients undergoing open meshectomy with/without selective neurectomy for chronic inguinodynia following Lichtenstein repair were analysed including a follow-up questionnaire. Outcome measures were complications, satisfaction (excellent, good, moderate, poor) and hernia recurrence rate. Recommendations for meshectomy are proposed based on a literature review.

Results

Seventy-four patients (67 males, median age 56 years) underwent mesh removal (exclusively mesh, 26%; combined with tailored neurectomy, 74%) between June 2006 and March 2015 in a single centre. Complications were intraoperatively recognized small bowel injury (n = 1) and testicular atrophy (n = 2). A 64% excellent/good long-term result was attained (median 18 months). Success rates of a meshectomy (63%) or combined with a neurectomy (64%) were similar. Five hernia recurrences occurred during follow-up (7%). A patient with a pure mesh-related groin pain characteristically reports a ‘foreign body feeling’. Pain intensifies during hip flexion (car driving) and is attenuated following hip extension or supine position. Palpation is painful along the inguinal ligament whereas neuropathic characteristics (hyperpathic skin, trigger points) are lacking.

Conclusions

Mesh removal either or not combined with tailored neurectomy is beneficial in two of three patients with characteristics of mesh-related inguinodynia following Lichtenstein hernia repair who are refractory to alternative pain treatments.

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References

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

    Article  PubMed  Google Scholar 

  2. Classification of Chronic Pain (1986) Descriptions of chronic pain syndromes and definitions of pain terms. Prepared by the international association for the study of pain, subcommittee on Taxonomy. Pain Suppl 3:S1–S226

    Google Scholar 

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

    Article  PubMed  Google Scholar 

  4. Franneby U, Sandblom G, Nordin P, Nyren O, Gunnarsson U (2006) Risk factors for long-term pain after hernia surgery. Ann Surg 244(2):212–219

    Article  PubMed  PubMed Central  Google Scholar 

  5. Simons MP, Aufenacker T, Bay-Nielsen M, Bouillot JL, Campanelli G, Conze J, de Lange D, Fortelny R, Heikkinen T, Kingsnorth A, Kukleta J, Morales-Conde S, Nordin P, Schumpelick V, Smedberg S, Smietanski M, Weber G, Miserez M (2009) European Hernia Society guidelines on the treatment of inguinal hernia in adult patients. Hernia 13(4):343–403

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Loos MJ, Scheltinga MR, Roumen RM (2010) Tailored neurectomy for treatment of postherniorrhaphy inguinal neuralgia. Surgery 147(2):275–281

    Article  PubMed  Google Scholar 

  7. Aasvang EK, Kehlet H (2009) The effect of mesh removal and selective neurectomy on persistent postherniotomy pain. Ann Surg 249(2):327–334

    Article  PubMed  Google Scholar 

  8. Campanelli G, Bertocchi V, Cavalli M, Bombini G, Biondi A, Tentorio T, Sfeclan C, Canziani M (2013) Surgical treatment of chronic pain after inguinal hernia repair. Hernia 17(3):347–353

    Article  CAS  PubMed  Google Scholar 

  9. Bischoff JM, Enghuus C, Werner MU, Kehlet H (2013) Long-term follow-up after mesh removal and selective neurectomy for persistent inguinal postherniorrhaphy pain. Hernia 17(3):339–345

    Article  CAS  PubMed  Google Scholar 

  10. Valvekens E, Nijs Y, Miserez M (2015) Long-term outcome of surgical treatment of chronic postoperative groin pain: a word of caution. Hernia 19(4):587–594

    Article  CAS  PubMed  Google Scholar 

  11. Amid PK (2004) Radiologic images of meshoma: a new phenomenon causing chronic pain after prosthetic repair of abdominal wall hernias. Arch Surg 139(12):1297–1298

    Article  PubMed  Google Scholar 

  12. Lange JF, Kaufmann R, Wijsmuller AR, Pierie JP, Ploeg RJ, Chen DC, Amid PK (2014) An international consensus algorithm for management of chronic postoperative inguinal pain. Hernia 19(1):33–43

    Article  PubMed  Google Scholar 

  13. Arlt GD, Lamm T, Klosterhalfen B (2003) Mesh removal in inguinal hernia repair. Eur Surg 35(1):42–44

    Article  Google Scholar 

  14. Madura JA, Madura JA 2nd, Copper CM, Worth RM (2005) Inguinal neurectomy for inguinal nerve entrapment: an experience with 100 patients. Am J Surg 189(3):283–287

    Article  PubMed  Google Scholar 

  15. Amid PK, Chen DC (2011) Surgical treatment of chronic groin and testicular pain after laparoscopic and open preperitoneal inguinal hernia repair. J Am Coll Surg 213(4):531–536

    Article  PubMed  Google Scholar 

  16. Delikoukos S, Fafoulakis F, Christodoulidis G, Theodoropoulos T, Hatzitheofilou C (2008) Re-operation due to severe late-onset persisting groin pain following anterior inguinal hernia repair with mesh. Hernia 12(6):593–595

    Article  CAS  PubMed  Google Scholar 

  17. Vuilleumier H, Hubner M, Demartines N (2009) Neuropathy after herniorrhaphy: indication for surgical treatment and outcome. World J Surg 33(4):841–845. doi:10.1007/s00268-008-9869-1

    Article  PubMed  Google Scholar 

  18. Zacest AC, Magill ST, Anderson VC, Burchiel KJ (2010) Long-term outcome following ilioinguinal neurectomy for chronic pain. J Neurosurg 112(4):784–789

    Article  PubMed  Google Scholar 

  19. Koopmann MC, Yamane BH, Starling JR (2011) Long-term follow-up after meshectomy with acellular human dermis repair for postherniorrhaphy inguinodynia. Arch Surg 146(4):427–431

    Article  PubMed  Google Scholar 

  20. Heise CP, Starling JR (1998) Mesh inguinodynia: a new clinical syndrome after inguinal herniorrhaphy? J Am Coll Surg 187(5):514–518

    Article  CAS  PubMed  Google Scholar 

  21. Aasvang EK, Jensen KE, Fiirgaard B, Kehlet H (2009) MRI and pathology in persistent postherniotomy pain. J Am Coll Surg 208(6):1023–1028 (discussion 1028–1029)

    Article  PubMed  Google Scholar 

  22. Rosen MJ, Novitsky YW, Cobb WS, Kercher KW, Heniford BT (2006) Combined open and laparoscopic approach to chronic pain following open inguinal hernia repair. Hernia 10(1):20–24

    Article  CAS  PubMed  Google Scholar 

  23. Keller JE, Stefanidis D, Dolce CJ, Iannitti DA, Kercher KW, Heniford BT (2008) Combined open and laparoscopic approach to chronic pain after inguinal hernia repair. Am Surg 74(8):695–700 (discussion 700–701)

    PubMed  Google Scholar 

  24. Magnusson N, Gunnarsson U, Nordin P, Smedberg S, Hedberg M, Sandblom G (2015) Reoperation for persistent pain after groin hernia surgery: a population-based study. Hernia 19(1):45–51

    Article  CAS  PubMed  Google Scholar 

  25. Dirksen CD, Beets GL, Go PM, Geisler FE, Baeten CG, Kootstra G (1998) Bassini repair compared with laparoscopic repair for primary inguinal hernia: a randomised controlled trial. Eur J Surg 164(6):439–447

    Article  CAS  PubMed  Google Scholar 

  26. Alfieri S, Amid PK, Campanelli G, Izard G, Kehlet H, Wijsmuller AR, Di Miceli D, Doglietto GB (2011) International guidelines for prevention and management of post-operative chronic pain following inguinal hernia surgery. Hernia 15(3):239–249

    Article  CAS  PubMed  Google Scholar 

  27. Voorbrood CE, Burgmans JP, Van Dalen T, Breel J, Clevers GJ, Wille F, Simmermacher RK (2015) An algorithm for assessment and treatment of postherniorrhaphy pain. Hernia 19(4):571–577

    Article  CAS  PubMed  Google Scholar 

  28. Miserez M, Peeters E, Aufenacker T, Bouillot JL, Campanelli G, Conze J, Fortelny R, Heikkinen T, Jorgensen LN, Kukleta J, Morales-Conde S, Nordin P, Schumpelick V, Smedberg S, Smietanski M, Weber G, Simons MP (2014) Update with level 1 studies of the European Hernia Society guidelines on the treatment of inguinal hernia in adult patients. Hernia 18(2):151–163

    Article  CAS  PubMed  Google Scholar 

  29. Kouhia S, Silvasti S, Kainulainen J, Hakala T, Paajanen H (2015) Magnetic resonance imaging has no role in diagnosing the origin of pain in patients with overwhelmingly painful inguinal hernia. Hernia 19(4):557–563

    Article  CAS  PubMed  Google Scholar 

  30. Zwaans WA, Verhagen T, Roumen RM, Scheltinga MR (2015) Factors determining outcome after surgery for chronic groin pain following a Lichtenstein hernia repair. World J Surg 39(11):2652–2662. doi:10.1007/s00268-015-3183-5

    Article  PubMed  Google Scholar 

  31. Baron R (2006) Mechanisms of disease: neuropathic pain—a clinical perspective. Nat Clin Pract Neurol 2(2):95–106

    Article  PubMed  Google Scholar 

  32. Loos MJ, Roumen RM, Scheltinga MR (2007) Classifying post-herniorrhaphy pain syndromes following elective inguinal hernia repair. World J Surg 31(9):1760–1765. doi:10.1007/s00268-007-9121-4 (discussion 1766–1767)

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

The authors thank Dr. J.P. Dieleman for her support and expertise regarding statistical analysis. We thank authors who responded to our e-mail and provided detailed data on their studies: Prof. H. Kehlet, Dr. C. Heise, Dr. J. Starling, Dr. E. Valvekens, Dr. G. Sandblom and Prof. G. Campanelli.

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Authors and Affiliations

  1. Department of General Surgery, Máxima Medical Centre, De Run 4600, P.O. Box 7777, 5500 MB, Veldhoven/Eindhoven, The Netherlands

    Willem A. R. Zwaans, Maarten J. A. Loos, Rudi M. H. Roumen & Marc R. M. Scheltinga

  2. Centre of Excellence for Abdominal Wall and Groin Pain, SolviMáx, Eindhoven, The Netherlands

    Willem A. R. Zwaans, Christel W. Perquin, Rudi M. H. Roumen & Marc R. M. Scheltinga

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  1. Willem A. R. Zwaans
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  2. Christel W. Perquin
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  3. Maarten J. A. Loos
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  4. Rudi M. H. Roumen
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  5. Marc R. M. Scheltinga
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Correspondence to Willem A. R. Zwaans.

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Zwaans, W.A.R., Perquin, C.W., Loos, M.J.A. et al. Mesh Removal and Selective Neurectomy for Persistent Groin Pain Following Lichtenstein Repair. World J Surg 41, 701–712 (2017). https://doi.org/10.1007/s00268-016-3780-y

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  • DOI: https://doi.org/10.1007/s00268-016-3780-y

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