An international consensus algorithm for management of chronic postoperative inguinal pain

Abstract

There is a need for guidelines with regard to management of CPIP. This algorithm can serve as a guide with regard to the diagnosis, management, and treatment of these patients and improve clinical outcomes. If an expectative phase of a few months has passed without any amelioration of CPIP, a multidisciplinary approach is indicated and a pain management team should be consulted. Pharmacologic, behavioral, and interventional modalities including nerve blocks are essential. If conservative measures fail and surgery is considered, triple neurectomy, correction for recurrence with or without neurectomy, and meshoma removal if indicated should be performed. Surgeons less experienced with remedial operations for CPIP should not hesitate to refer their patients to dedicated hernia surgeons.

Surgical interventions for the management of chronic groin pain after hernia repair (postherniorrhaphy inguinodynia) in adults

“…Surgical interventions are usually considered as a last option once pain is recalcitrant. (Lange 2015). The number of neurectomies depends on the preference of the attending surgeon.…”

Remedial robot-assisted laparoscopic surgery in the treatment of neuropathic inguinodynia and repair of inguinal hernia

“…Nerve blocks interfere with neural transmission and can temporarily reduce neuralgia, serving therapeutic and diagnostic capabilities. [1] Nonetheless, there is paucity in the literature on success rates of nerve blocks as a treatment option for neuropathic inguinodynia. [3,10] Further, their temporary effect and requirement for multiple administrations represents a drawback of their use as a therapeutic modality.…”

“…[16] However, foreign body removal alone does not always lead to favorable results as it might fail to address irreversible nerve damage that may have been established, which can continue to be a source of neuropathic pain. [1] Heise et al demonstrated that mesh removal plus neurectomy led to pain relief in 62% of chronic inguinodynia patients. [14] Ultimately, the results in our patient after combined mesh replacement and ilioingual neurectomy, were excellent.…”

“…Knowledge of the inguinal neuroanatomy and meticulous preservation of the three inguinal nerves is believed to reduce the risk of nerve damage. [1,6,9] Additionally, using the appropriate mesh type and fixation materials during the initial hernia repair have also been shown to decrease the chance of foreign body reaction, nerve entrapment, and chronic pain. [9] Using absorbable sutures, as undertaken in our case, and reducing the number of tacks or sutures used to fixate a mesh have been shown to reduce the incidence of inguinodynia by preventing nerve entrapment.…”

“…[1] Prevalence rates for inguinodynia after an open or laparoscopic hernia repair are highly variable and range from 1%-63%, [1] with an estimated 12%-25% of these patients experiencing pain that interferes with their daily activities. [2,3] Remedial surgery is often required for management.…”