Henri Vuilleumier1, Martin Hübner, Nicolas Demartines. 1. Department of Visceral Surgery, Centre Hospitalier Universtaire Vaudois (CHUV), University Hospital, Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland. henri.vuilleumier@chuv.ch
Abstract
BACKGROUND: Chronic neuropathy after hernia repair is a neglected problem as very few patients are referred for surgical treatment. The aim of the present study was to assess the outcome of standardized surgical revision for neuropathic pain after hernia repair. METHODS: In a prospective cohort study we evaluated all patients admitted to our tertiary referral center for surgical treatment of persistent neuropathic pain after primary herniorrhaphy between 2001 and 2006. Diagnosis of neuropathic pain was based on clinical findings and a positive Tinel's sign. Postoperative pain was evaluated by a visual analogue scale (VAS) and a pain questionnaire up to 12 months after revision surgery. RESULTS: Forty-three consecutive patients (39 male, median age 35 years) underwent surgical revision, mesh removal, and radical neurectomy. The median operative time was 58 min (range: 45-95 min). Histological examination revealed nerve entrapment, complete transection, or traumatic neuroma in all patients. The ilioinguinal nerve was affected in 35 patients (81%); the iliohypogastric nerve, in 10 patients (23%). Overall pain (median VAS) decreased permanently after surgery within a follow-up period of 12 months (preoperative 74 [range: 53-87] months versus 0 [range: 0-34] months; p<0.0001). CONCLUSIONS: The results of this cohort study suggest that surgical mesh removal with ilioinguinal and iliohypogastric neurectomy is a successful treatment in patients with neuropathic pain after hernia repair.
BACKGROUND:Chronic neuropathy after hernia repair is a neglected problem as very few patients are referred for surgical treatment. The aim of the present study was to assess the outcome of standardized surgical revision for neuropathic pain after hernia repair. METHODS: In a prospective cohort study we evaluated all patients admitted to our tertiary referral center for surgical treatment of persistent neuropathic pain after primary herniorrhaphy between 2001 and 2006. Diagnosis of neuropathic pain was based on clinical findings and a positive Tinel's sign. Postoperative pain was evaluated by a visual analogue scale (VAS) and a pain questionnaire up to 12 months after revision surgery. RESULTS: Forty-three consecutive patients (39 male, median age 35 years) underwent surgical revision, mesh removal, and radical neurectomy. The median operative time was 58 min (range: 45-95 min). Histological examination revealed nerve entrapment, complete transection, or traumatic neuroma in all patients. The ilioinguinal nerve was affected in 35 patients (81%); the iliohypogastric nerve, in 10 patients (23%). Overall pain (median VAS) decreased permanently after surgery within a follow-up period of 12 months (preoperative 74 [range: 53-87] months versus 0 [range: 0-34] months; p<0.0001). CONCLUSIONS: The results of this cohort study suggest that surgical mesh removal with ilioinguinal and iliohypogastric neurectomy is a successful treatment in patients with neuropathic pain after hernia repair.
Authors: A R Wijsmuller; R N van Veen; J L Bosch; J F M Lange; G J Kleinrensink; J Jeekel; J F Lange Journal: Br J Surg Date: 2007-01 Impact factor: 6.939
Authors: Martin McCarthy; Chih-Hung Chang; A Simon Pickard; Anita Giobbie-Hurder; Donald D Price; Olga Jonasson; James Gibbs; Robert Fitzgibbons; Leigh Neumayer Journal: J Am Coll Surg Date: 2005-08 Impact factor: 6.113
Authors: Amudha S Poobalan; Julie Bruce; W Cairns S Smith; Peter M King; Zygmunt H Krukowski; W Alastair Chambers Journal: Clin J Pain Date: 2003 Jan-Feb Impact factor: 3.442
Authors: Sergio Alfieri; Fabio Rotondi; Andrea Di Giorgio; Uberto Fumagalli; Antonio Salzano; Dario Di Miceli; Marco Pericoli Ridolfini; Antonio Sgagari; Giovannibattista Doglietto Journal: Ann Surg Date: 2006-04 Impact factor: 12.969
Authors: Martin Hübner; Markus Schäfer; Hicham Raiss; Nicolas Demartines; Henri Vuilleumier Journal: Langenbecks Arch Surg Date: 2010-07-03 Impact factor: 3.445