Long-term Follow-up After Meshectomy With Acellular Human Dermis Repair for Postherniorrhaphy Inguinodynia

Koopmann, Matthew C.; Yamane, Brett; Starling, James R.

doi:10.1001/archsurg.2011.49

Cited by 13 publications

(9 citation statements)

References 19 publications

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“…Five studies were retrospective case series. 257 – 259 , 261 , 263 Efficacy rates in significantly reducing or eliminating pain ranged from 60 to 100%. Data on the effect of mesh removal alone cannot easily be extracted, since the majority combined mesh removal with a tailored or triple neurectomy (82%).…”

Section: Pain: Prevention and Treatmentmentioning

confidence: 99%

International guidelines for groin hernia management

Simons¹,

Śmietański²,

Bonjer³

et al. 2018

Hernia

1,309

580

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IntroductionWorldwide, more than 20 million patients undergo groin hernia repair annually. The many different approaches, treatment indications and a significant array of techniques for groin hernia repair warrant guidelines to standardize care, minimize complications, and improve results. The main goal of these guidelines is to improve patient outcomes, specifically to decrease recurrence rates and reduce chronic pain, the most frequent problems following groin hernia repair. They have been endorsed by all five continental hernia societies, the International Endo Hernia Society and the European Association for Endoscopic Surgery.MethodsAn expert group of international surgeons (the HerniaSurge Group) and one anesthesiologist pain expert was formed. The group consisted of members from all continents with specific experience in hernia-related research. Care was taken to include surgeons who perform different types of repair and had preferably performed research on groin hernia surgery. During the Group’s first meeting, evidence-based medicine (EBM) training occurred and 166 key questions (KQ) were formulated. EBM rules were followed in complete literature searches (including a complete search by The Dutch Cochrane database) to January 1, 2015 and to July 1, 2015 for level 1 publications. The articles were scored by teams of two or three according to Oxford, SIGN and Grade methodologies. During five 2-day meetings, results were discussed with the working group members leading to 136 statements and 88 recommendations. Recommendations were graded as “strong” (recommendations) or “weak” (suggestions) and by consensus in some cases upgraded. In the Results and summary section below, the term “should” refers to a recommendation. The AGREE II instrument was used to validate the guidelines. An external review was performed by three international experts. They recommended the guidelines with high scores.Results and summaryThe risk factors for inguinal hernia (IH) include: family history, previous contra-lateral hernia, male gender, age, abnormal collagen metabolism, prostatectomy, and low body mass index. Peri-operative risk factors for recurrence include poor surgical techniques, low surgical volumes, surgical inexperience and local anesthesia. These should be considered when treating IH patients. IH diagnosis can be confirmed by physical examination alone in the vast majority of patients with appropriate signs and symptoms. Rarely, ultrasound is necessary. Less commonly still, a dynamic MRI or CT scan or herniography may be needed. The EHS classification system is suggested to stratify IH patients for tailored treatment, research and audit. Symptomatic groin hernias should be treated surgically. Asymptomatic or minimally symptomatic male IH patients may be managed with “watchful waiting” since their risk of hernia-related emergencies is low. The majority of these individuals will eventually require surgery; therefore, surgical risks and the watchful waiting strategy should be discussed with patients. Surgical treatment s...

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Section: Pain: Prevention and Treatmentmentioning

confidence: 99%

International guidelines for groin hernia management

Simons¹,

Śmietański²,

Bonjer³

et al. 2018

Hernia

1,309

580

View full text Add to dashboard Cite

show abstract

“…They noted that meshectomy for postherniorrhaphy pain led to significant symptom improvement and patient satisfaction, with acceptable morbidity and recurrence rates. 12 Furthermore, ilioinguinal neurectomy played no role in long-term pain outcome, suggesting again that the mesh may be the culprit for the pain. Another study of 20 patients, by Heise and Starling, 13 reported that removal improved symptoms in 57% of their patients who were experiencing postherniorrhaphy inguinodynia.…”

Section: Discussionmentioning

confidence: 99%

“…Biologic meshes have been used to repair the defect, but studies have failed to show improvement over an anatomic repair in terms or pain or recurrence. 12 Furthermore, cost is a significant factor to consider when placing a new prosthetic or biologic product versus doing a primary repair. Reports of recurrence with a transversalis repair done with experience and adequate skill are noted to be between 4% and 6%, 15 although specialty centers, such as Shouldice, have recurrence rates as low as 1.5%.…”

Section: Discussionmentioning

confidence: 99%

Is It the Mesh?

Woods

Syrquin

2018

International Surgery

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It is well known that after inguinal herniorrhaphy, some patients develop inguinodynia. Pain has often been blamed on injury or entrapment of the ilioinguinal nerve. Since the advent of mesh, we have noticed a number of patients with persistent pain even after the ilioinguinal nerve has been transected or blocked. For that reason, a retrospective review was done to analyze whether the mesh could be a culprit for this chronic pain syndrome. A total of 12 cases were reviewed. All patients underwent exploration of the inguinal area, along with removal of the previous mesh and herniorraphy with a McVay technique. After exploration and removal of the mesh, the inguinal pain was greatly improved within 2 months of the time of surgery in all 12 patients. Despite changes in mesh manufacturing and hernia repair technique, we believe that there is a possible correlation between the mesh and inguinodynia in a certain subset of patients that seems to be unrelated to nerve pathology. This correlation may prompt revision in training surgical residents in primary tissue repair and may lead to further investigations regarding patient response to inguinal mesh placement.

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“…[1] Meshectomy (with or without neurectomy) in these patients has been shown to improve symptoms and patient satisfaction with acceptable recurrence rate and morbidity. [3]…”

Section: Discussionmentioning

confidence: 99%

“…The treatment options vary from oral analgesics, nerve blocks or neurolysis to surgical exploration and meshectomy (with or without neurectomy) or triple neurectomy only. [23]…”

Section: Introductionmentioning

confidence: 99%