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A mechanism of mesh-related post-herniorrhaphy neuralgia

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Abstract

Purpose

The objective is to compare nerve densities in explanted polypropylene meshes in patients with or without chronic pain. Pain has supplanted recurrences as a complication of hernia surgery. The increased incidence of pain mirrors a parallel increase in the use of polypropylene meshes. Neither triple neurectomy nor careful nerve preservation has brought relief. Perhaps because we have forgotten that nerves, in response to some evolutionary mechanism, tend to regenerate, undergo changes imposed by prosthetic elements and architecture, mimicking entrapment and compartment syndromes.

Methods

A total of 33 hernia meshes have been analyzed: 17 excised due to severe pain, two for combined pain and recurrence, 14 sampled during revision for recurrence without pain. Each mesh had standardized sampling for histology and the nerves were highlighted by S100 stain. Nerve densities were assessed within the mesh spaces and in tissue outside the mesh.

Results

The density of nerves present in the standardized mesh samples of patients complaining of pain was much more elevated than in the mesh of those patients who had a recurrence but no pain. The difference was statistically significant (p < 0.001). Excluding two patients who had both pain and recurrence, the difference was even more marked (p < 0.0001).

Conclusions

Re-innervation and neo-innervation are known to take place following hernia repairs in indigenous tissue as well as through polypropylene meshes. However, when pain is an overriding issue dictating mesh explant, the degree of mesh innervation is significantly higher when compared to mesh excised for recurrence. That increase has been confirmed statistically.

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Notes

  1. The Algea were the spirits of pain, suffering, grief, sorrow and distress. Greek Mythology.

References

  1. Czerny V (1878) Beitrage zur Operativen Chirurgie. Verlag Von Ferdinand Enke, Stuttgart

  2. Bendavid R (1998) Complications of groin hernia surgery. Surg Clin North Am 78(6):1089–1103

    Article  CAS  PubMed  Google Scholar 

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

    Article  Google Scholar 

  4. Gukas ID, Massouh F (2011) Serious life threatening complication 5 years after laparoscopic totally extraperitoneal hernia repair: case report and discussion of the literature. Hernia 15:459–462

    Article  CAS  PubMed  Google Scholar 

  5. Kocot A, Gerharz EW, Riedmiller H (2011) Urological complications of laparoscopic inguinal hernia repair: a case series. Hernia 15:583–586

    Article  CAS  PubMed  Google Scholar 

  6. Moussi A, Daldoul S, Bourguiba B (2012) Gas gangrene of the abdominal wall due to late-onset enteric fistulas after polyester mesh repair of an incisional hernia. Hernia 16:215–217

    Article  CAS  PubMed  Google Scholar 

  7. Novaretti JPT, Silva RDP, Cotrim CAC et al (2012) Migration mesh mimicking bladder malignancy after open inguinal hernia repair. Hernia 16:467–470

    Article  CAS  PubMed  Google Scholar 

  8. Langer C, Neufang T, Kley C et al (2001) Central mesh recurrence after incisional hernia repair wit Marlex-are meshes strong enough? Hernia 5:164–167

    Article  CAS  PubMed  Google Scholar 

  9. Kunishige T, Takayama T, Matumoto S et al (2013) A defect of the abdominal wall with intestinal fistulas after the repair of incisional hernia using Composix Kugel patch. Int J Surg Case report 4(9):793–797

    Article  Google Scholar 

  10. Garcia Ureña MA, Hidalgo M, Feliu X et al (2011) Multicentric observational study of pain after use of a self gripping lightweight mesh. Hernia 15:511–515

    Article  PubMed  Google Scholar 

  11. Shin D, Lipshutz LI, Goldstein M et al (2005) Herniorrhaphy with polypropylene mesh causing inguinal vasal obstruction. a preventable cause of obstructive azoospermia. Ann Surg 241(4):553–558

    Article  PubMed  PubMed Central  Google Scholar 

  12. Yamaguchi K, Ishikawa T, Nakano Y et al. (2008) Rapidly progressing, late onset obstructive azoospermia linked to herniorrhaphy with mesh. Fertil Steril 90(5):5–7

    Article  Google Scholar 

  13. Fitzgibbons R J (2005). Can we be sure polypropylene mesh causes infertility? Ann Surg 241(4):1297–1298

    Article  Google Scholar 

  14. Corcione F, Cuccurullo D (2009) Teaching and learning in abdominal wall surgery: where are we going? Hernia 13(1):101–102

    Article  CAS  PubMed  Google Scholar 

  15. Hernia The EU, Collaboration Trialists (2002) Repair of groin hernia with synthetic mesh. meta-analysis of randomized controlled trials. Ann Surg 2002(235):322–332

    Google Scholar 

  16. 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

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Page B, Paterson D, Young D, O’Dwyer PJ (2002) Pain from primary inguinal hernia and the effect of repair on pain. Br J Surg 89:1315–1318

  18. Nienhuijs SW, Boelens OBA, Strobbe LJA (2005) Pain after anterior mesh hernia repair. J Am Coll Surg 200(6):885–889

    Article  PubMed  Google Scholar 

  19. Aasvang E, Kehlet H (2004) Chronic postoperative pain: the case of inguinal herniorrhaphy. Br J Anaesth 95(1):69–76

    Article  PubMed  Google Scholar 

  20. Kehlet H, Jensen TS, Woolf CJ (2006) Persistent postsurgical pain:risk factors and prevention. Lancet 367(9522):1618–1625

    Article  PubMed  Google Scholar 

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

    Article  Google Scholar 

  22. Poobalan AS, Bruce J, Smith WC, King PM, Krukowski ZH et al (2002) A review of chronic pain after inguinal herniorrhaphy. Clin J Pain 19(1):48–54

    Article  Google Scholar 

  23. Ferzli GS, Edwards E, Al-Khoury G, Hardin R (2008) Post-herniorrhaphy groin pain and how to avoid it. Surg Clin North Am 88(1):203–216

    Article  PubMed  Google Scholar 

  24. Aasvang EK, Bittner R, Kehlet H (2010) Predictive risk factors for persistent postherniotomy pain. Anesthesiology 112(4):957–969

    Article  PubMed  Google Scholar 

  25. Linderoth G, Kehlet H, Aasvang EK et al (2011) Neurophysiological characterization of persistent pain after laparoscopic inguinal hernia repair. Hernia 15:521–529

    Article  CAS  PubMed  Google Scholar 

  26. 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):1–7

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Bendavid R, Lou W, Koch A et al (2014) Mesh-related sin syndrome. a surreptitious irreversible neuralgia and its morphologic background in the etiology of post-herniorrhaphy pain. Int J Cl Med 5:799–810

    Article  Google Scholar 

  28. Amid PK (2004) Causes, prevention and surgical treatment of post-herniorrhaphy neuropathic inguinodynia: triple neurectomy with proximal end implantation. HERNIA 8:343–349

    Article  CAS  PubMed  Google Scholar 

  29. Kehlet H, Bischof JM, Aasvang EK (2012) Intraoperative nerve identification and chronic postherniorrhaphy pain. Hernia 16:583

    Article  Google Scholar 

  30. Greenberg J (2014) Prophylactic neurectomy during inguinal hernia repair to prevent chronic inguinodynia: does it work? In: Paper presented at the 16th Annual Hernia Repair; March 12-15, 2014, Hernia 18 Supplement 1 IP 160:S15, Las Vegas, USA

  31. Petersen, Kevin C. (2015). Results of hernia mesh removals for pain. 1st World Congress on Abdominal Wall Hernia Surgery. Milan, Italy, April 25–29

  32. Klosterhalfen B, Junge K, Klinge U (2005) The lightweight and large porous mesh concept for hernia repair. Expert Rev Med Devices 2(1):103–117

    Article  PubMed  Google Scholar 

  33. Miller J, Acar F, Kaimaktchiev V, Gultekin S, Burchiel K (2008) Pathology of ilioinguinal neuropathy produced by mesh entrapment: case report and literature review. Hernia 12:213–216

    Article  CAS  PubMed  Google Scholar 

  34. Coda A, Bendavid R, Botto-Micca F et al (2003) Structural alterations of prosthetic meshes in humans. Hernia 7:29–34

    CAS  PubMed  Google Scholar 

  35. Gatt MT, Chevrel JP (1992) The treatment of neuralgias following inguinal herniorrhaphy: a report of 47 cases. Postgrad Gen Surg 4(2):142–147

    Google Scholar 

  36. Langer C, Forster H, Konietschke F (2010) Mesh shrinkage in hernia surgery: data from a prospective randomized double-blinded clinical study. Chirurg 81(8):735–742

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

We would like to gratefully acknowledge the able assistance of E. Frysberg in providing his technical expertise in the design and illustrations in our submission. R. Bendavid, V. Iakovlev et al.

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Authors and Affiliations

  1. Shouldice Hospital, 7750 Bayview Avenue, Thornhill, ON, L3T 4A3, Canada

    R. Bendavid

  2. Department of Biostatistics, Dalla Lan School of Public Health, University of Toronto, Toronto, Canada

    W. Lou

  3. Day Surgery and Hernia Center, Gerhard-Hauptman Str. 15, Cottbus, Germany

    A. Koch

  4. Ohio Hernia Center, Cleveland, OH, USA

    D. Grischkan

  5. Chatham Kent Health Alliance, Chatham, ON, Canada

    J. Morrison

  6. Las Vegas, NV, USA

    K. Petersen

  7. Division of Pathology, Department of Laboratory Medicine and Pathobiology, Keenan Research Centre of the Li Ka Shing Knowledge Institute, University of Toronto, Toronto, Canada

    V. Iakovlev

  8. St Michael’s Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada

    V. Iakovlev

  9. University of Toronto, Toronto, Canada

    R. Bendavid

Authors
  1. R. Bendavid
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  2. W. Lou
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  3. D. Grischkan
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  4. A. Koch
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  5. K. Petersen
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  6. J. Morrison
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  7. V. Iakovlev
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Correspondence to R. Bendavid.

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Bendavid, R., Lou, W., Grischkan, D. et al. A mechanism of mesh-related post-herniorrhaphy neuralgia. Hernia 20, 357–365 (2016). https://doi.org/10.1007/s10029-015-1436-8

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  • DOI: https://doi.org/10.1007/s10029-015-1436-8

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