Abstract
Background
Chronic groin pain is defined as pain arising 3–6 months after inguinal hernia repair that can compromise the patient’s quality of life. Many articles in the literature report clinical presentation, but there are no well-defined indications and protocols of treatment.
Methods
Forty-six patients underwent surgical treatment for chronic groin pain that consisted of a simultaneous double approach, anterior and posterior, to the inguinal region, with 44 triple neurectomies and 2 iliohypogastric neurectomies. Ilio-inguinal and ilio-hypogastric nerves were resected by anterior approach, while genitofemoral trunk was resected by a posterior pre-peritoneal approach. Mesh was removed in 24 cases, and mesh and plug were removed in 16 cases. A new mesh repair was performed in 42 cases. All the patients were examined 1 week, 1 month and 1 year postoperatively.
Results
In 40 patients, the surgical treatment has obtained good response with improvement or complete resolution of the pain. Two patients referred persistent groin pain different from preoperative and in 4 cases the pain persisted without substantial benefit. Mean VAS value was 7.89 before surgery and 1.89 after surgery.
Conclusions
Choice of the adequate therapy of chronic groin pain after inguinal hernia repair is still controversial. Our surgical approach turned out to be a safe and effective procedure. In this way, an accurate exploration of the whole inguinal region can be performed along with the identification of the nerves involved. Anyway in a certain number of cases, the resolution of pain cannot be achieved; this suggests a possible involvement of differences in the single personality and tolerances of pain in the different patients.
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References
Aasvang E, Kehlet H (2005) Surgical management of chronic pain after inguinal hernia repair. Br J Surg 92:795–801
Poobalan AS, Bruce J, Smith WC et al (2003) A review of chronic pain after inguinal herniorrhaphy. Clin J Pain 19:48–54
Kehlet H, Jensen TS, Woolf CJ (2006) Persistent postsurgical pain: risk factors and prevention. Lancet 367:1618–1625
Madura JA, Copper CM, Worth RM (2005) Inguinal neurectomy for inguinal nerve entrapment: an experience with 100 inguinal patients. Am J Surg 189:283–287
Rosen MJ, Novitsky YW, Cobb WS et al (2006) Combined open and laparoscopic approach to chronic pain following open inguinal hernia repair. Hernia 10:20–24
Dittrick GW, Ridl K, Kuhn JA et al (2004) Routine ilioinguinal nerve excision in inguinal hernia repair. Am J Surg 188:736–740
Palumbo P, Minicucci A, Nasti AG et al (2007) Treatment for persistent chronic neuralgia after inguinal hernioplasty. Hernia 11:527–531
Bay-Nielsen M, Perkins FM, Kehlet H (2001) Pain and functional impairment 1 year after inguinal herniorrhaphy: a nationwide questionnaire study. Ann Surg 233:1–7
Courtney CA, Duffy K, Serpell MG et al (2002) Outcome of patients with severe chronic pain following repair of groin hernia. Br J Surg 89:1310–1314
Bay-Nielsen M, Nilsson E, Nordin P et al (2004) Chronic pain after open mesh and sutured repair of indirect hernia in young males. Br J Surg 91:1372–1376
Campanelli G et al (2008) Randomized, controlled, blinded trial of Tissucol/Tisseel for mesh fixation in patients undergoing Lichtenstein technique for primary inguinal hernia repair: rationale and study design of the TIMELI trial. Hernia 12(2):159–165
Alfieri S, Di Miceli D, Doglietto GB (2007) Prophylactic ilioinguinal neurectomy in open inguinal hernia repair. Ann Surg 245:663
Starling JR, Hams BA (1994) Ilioinguinal, iliohypogastric and genitofemoral neuralgia. In: Bendavid R (ed) Prosthesis and abdominal wall hernia. Rg Landes, Austin, TX, pp 351–356
Amid PK (2004) Radiological images of meshoma: a new phenomenon after prosthetic repair of abdominal wall hernia. Arch Surg 139:1297–1298
Heise CP, Starling JR (1998) Mesh inguinodynia: a new clinical syndrome after inguinal herniorrhaphy? J Am Coll Surg 187:514–518
Bower S, Moore BB, Weiss SM (1996) Neuralgia after inguinal hernia repair. Am Surg 62:664–667
Starling JR, Harms BA (1989) Diagnosis and treatment of genitofemoral and ilioinguinal neuralgia. World J Surg 13:586–591
Lichtenstein IL, Shulman AG, Amid PK (1998) Cause and prevention of postherniorrhaphy neuralgia: a proposed protocol for treatment. Am J Surg 155:786–790
Amid PK (2002) A 1-stage surgical treatment for postherniorrhaphy neuropathic pain: triple neurectomy and proximal end implantation without mobilization of the cord. Arch Surg 137:100–104
Krahenbuhl L, Striffeler H, Baer HU et al (1997) Retroperitoneal, endoscopic neurectomy for nerve entrapment after hernia repair. Br J Surg 84:216–219
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
Callesen T, Bech K, Kehlet H (1999) Prospective study of chronic pain after groin hernia repair. Br J Surg 86:1528–1531
Franneby U, Sandblom G, Nordin P et al (2006) Risk factors for long-term pain after hernia surgery. Ann Surg 244:212–219
Picchio M, Palimento D, Attanasio U et al (2004) Randomized controlled trial of preservation or elective division of ilioinguinal nerve on open inguinal hernia repair with polypropylene mesh. Arch Surg 139:755–758
Bartlett DC, Porter C, Kingsnorth AN (2007) A pragmatic approach to cutaneous nerve division during open inguinal hernia repair. Hernia 11:243–246
Alfieri S, Rotondi F, Di Giorgio A et al (2006) Influence on preservation versus division of ilioinguinal, iliohypogastric and genital nerves during open mesh herniorrhaphy: prospective multicentric study of chronic pain. Ann Surg 243:553–558
Grant AM, Scott NW, O’Dwyer PJ (2004) Five-year follow-up of a randomized trial to assess pain and numbness after laparoscopic or open repair of groin hernia. Br J Surg 91:1570–1574
Simons MP et al (2009) European Hernia Society guidelines on the treatment of inguinal hernia in adult patients. Hernia 13:343–403
Callesen T, Bech K, Nielsen R et al (1998) Pain after groin hernia repair. Br J Surg 85:1412–1414
Lau H, Lee F (2001) Determinant factors of pain after ambulatory inguinal herniorrhaphy: a multi-variate analysis. Hernia 5:17–20
Kehlet H (2008) Chronic pain after groin hernia repair. Br J Surg 95:135–136
Amid PK, Hiatt JR (2007) New understanding of the causes and surgical treatment of postherniorrhaphy inguinodynia and orchalgia. J Am Coll Surg 205:381–385
Wijsmuller AR, van Veen RN, Bosch JL et al (2007) Nerve identifying inguinal hernia repair: a surgical anatomical study. World J Surg 94:17–22
Pappalardo G, Frattaroli FM, Mongardini M et al (2007) Neurectomy to prevent persistent pain after inguinal herniorrhaphy: a prospective study using objective criteria to assess pain. World J Surg 31:1081–1086
Mui WL, Ng CS, Fung TM et al (2006) Prophylactic ilioinguinal neurectomy in open inguinal hernia repair: a double-blind randomized controlled trial. Ann Surg 244:27–33
Ravichandran D, Kalambe BG, Pain GA (2000) Pilot randomized controlled study of preservation or division of ilioinguinal nerve in open mesh repair of inguinal hernia. Br J Surg 87:1166–1167
Alfieri et al (2011) International guidelines for prevention and management of post-operative chronic pain following inguinal hernia surgery. Hernia 15(3):239–249
Lee CH, Dellon AL (2000) Surgical management of groin pain of neural origin. J Am Coll Surg 191:137–142
Aasvang EK et al (2010) Predictive risk factors for persistent postherniotomy pain. Anesthesiology 112(4):957–969
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All authors declare that they do not have any kind of conflict of interest regarding the text of this paper.
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Campanelli, G., Bertocchi, V., Cavalli, M. et al. Surgical treatment of chronic pain after inguinal hernia repair. Hernia 17, 347–353 (2013). https://doi.org/10.1007/s10029-013-1059-x
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DOI: https://doi.org/10.1007/s10029-013-1059-x