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Management of persistent postsurgical inguinal pain

  • Review Article
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Langenbeck's Archives of Surgery Aims and scope Submit manuscript

Abstract

Purpose

Severe persistent pain is a major postsurgical complication affecting 2–4 % of patients following inguinal hernia repair and may cause critical physical and socioeconomic disability. This review introduces relevant criteria and analyses the current evidence base underlying recommended management strategies.

Results

Development of persistent postsurgical pain (PPP) following inguinal hernia repair cannot automatically be considered to follow a simple trajectory from acute to chronic pain. Surgical management comprising neurectomy with or without meshectomy was described in 25 studies. Local anesthetic blocks, pharmacological management, and treatment with sensory stimulation methods were presented in seven studies. In spite of shortcomings, the data on surgical management demonstrate that neurectomy with or without mesh removal may provide long-lasting analgesic effects in most patients with severe PPP following inguinal hernia repair. The evidence base for other management methods is still fragile, although promising results appear in the neuromodulation studies.

Conclusions

There is a need for improved study designs and, launching of large multicenter collaborative studies supplying the necessary long-term data for recommendation of future management strategies.

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Notes

  1. 2,000 inguinal hernia repairs per year per million inhabitants; population in Germany, 80 million.

  2. Calculated in studyi as: follow-up weeksi x (number of patientsi/total number of patients). Values for each study are summed up giving a weighted mean value.

  3. Calculated in studyi as: pain relief ratioi x (number of patientsi/total number of patients). Ratios for each study are summed up giving a weighted mean ratio.

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Acknowledgments

The author is indebted to Joakim M. Bischoff M.D. for valuable help and discussions of the manuscript.

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  1. Multidisciplinary Pain Center, Neuroscience Center, Rigshospitalet, Copenhagen University Hospitals, Blegdamsvej 9, 2100, Copenhagen, Denmark

    Mads U. Werner

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Werner, M.U. Management of persistent postsurgical inguinal pain. Langenbecks Arch Surg 399, 559–569 (2014). https://doi.org/10.1007/s00423-014-1211-9

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