A Simplified clinical algorithm for standardized surgical treatment of chronic pain after inguinal hernia repair: A quality assessment study

Abstract

Background: The optimal surgical strategy for the treatment of chronic pain after inguinal hernia repair is controversial and based on relatively weak evidence. The purpose of this study was to analyze pain-related functional impairment using a simplified clinical treatment algorithm for a standardized surgical treatment. The algorithm was predefined, and the indication to operate was based on strict criteria. Methods: This was a prospective, non-controlled, explorative study. The pain operation was either open triple neurectomy with total mesh removal or laparoscopic retroperitoneal triple neurectomy. A clinically relevant postoperative change was defined as ⩾25% change from the baseline level. Primary outcome was pain-related impairment of physical function using the Activity Assessment Scale. Secondary outcomes included Individual Patient-Reported Outcome Measures, Hospital Anxiety and Depression Scale, and PainDETECT Questionnaire. Results: A total of 240 patients were referred (2016–2019). Sixty-six patients were included for the analysis. A total of 25% of referred patients were offered a pain operation. Follow-up was a median 3 months (range: 3–13). Activity Assessment Scale scores were clinically relevant improved in 43 patients (68%), not clinically relevant different in 19 (30%), and clinically relevant worsened in one (2%). Secondary outcome scores were all significantly improved ( P < 0.05) except for the risk of postoperative depression ( P = 0.092). Fifty-one patients (77%) reported that chronic groin pain was reduced after the operation. Conclusion: Pain-related functional impairment was improved with clinical relevance in roughly 70% of patients through a simplified clinical algorithm for surgical treatment of severe chronic pain after an inguinal hernia repair.

Is pain control for chronic neuropathic pain after inguinal hernia repair using endoscopic retroperitoneal neurectomy effective? A meta-analysis of 142 patients from 1995 to 2022

“…These five papers were appropriate for meta-analysis and systematic review (Fig. 4 ) [ 3 , 4 , 8 , 18 , 21 ]. The study characteristics are described and summarized in Table 2 .…”

“…Pain reduction was defined as statistically significant pain reduction based on pre- and postoperative questionnaire scores. Questionnaires used in analysed studies include the following: NRS-11: Numeric Rating Scale; I-PROM: Individual Patient-Reported Outcome Measure; NRS: Numerical Rating Scale; PDQ: PainDETECT Questionnaire [ 3 , 4 , 8 , 18 , 21 ].…”

“…However, persistent severe symptoms could lead to substantial morbidity and surgical reintervention. It is reported these symptoms are less likely to occur and less likely to be severe using minimally invasive methods [ 8 ].…”

Somatosensory Outcomes Following Re-Surgery in Persistent Severe Pain After Groin Hernia Repair: A Prospective Observational Study

“…Four studies of mesh removal and/or neurectomy in patients with PSPG have included an assessment of ADL-outcomes. Three of these included a modified AAS questionnaire and showed significant group-level improvement in ADL-outcomes after three months, 54 six months, 12 and five-year follow-up (median follow-up time 2.2 (1.9 to 2.8) months). 8 One of these studies compared outcomes of patients allocated to either re-surgery or pharmacotherapy.…”

“…The overall success rate has ranged from 33-100% in retrospective studies 8,49-52 and 63-100% in corresponding prospective cohort studies. [53][54][55][56][57][58] In the current study, the initial GHR and the re-surgery were performed by an open surgical approach. In comparable studies, 10,12,59 significant improvements in pain intensities (NRS) on average, 10,12,59 at rest, activity-related and maximal, 10,12 have been observed, with follow-up intervals ranging from 6 to 36 months.…”