Nerve Management and Chronic Pain After Open Inguinal Hernia Repair

Reinpold, Wolfgang; Nehls, Jennifer; Eggert, A

doi:10.1097/sla.0b013e31821d4a2d

Cited by 108 publications

(102 citation statements)

References 40 publications

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“…This series has given some clarity to the issue of nerve mobilization, clearly demonstrating that this should be avoided. The first main conclusion of Reinpold's article is ''The nerves should always be visualized, and handled with care [9]. '' We hope that the conclusion that ''nerve identification had no influence on persistent pain'' is not taken out of the context of this study promoting careless nerve handling, leading to patient disability and surgeon liability.…”

Section: Dear Editorsmentioning

confidence: 95%

“…Importantly, the authors comment that such a comparison with a ''group with no nerve identification would be somewhat unethical based on previous literature.'' In regard to the citation in the discussion that Reinpold's article of long-term 5-year data of nerve management and rates of chronic pain ''suggest[s] that other factors rather than nerve identification are important,'' the conclusions from that study are not directly comparable [9]. This longitudinal series did not specifically focus on defining the role of nerve identification with the IIN, IHN, and GB identified in only 88.0, 45.3, and 38.2 % of the cases, respectively.…”

Section: Dear Editorsmentioning

confidence: 99%

See 1 more Smart Citation

Questioning the favorable influence of nerve identification during open inguinal herniorrhaphy is misleading and may increases the risk of surgeons’ liability

Chen

Amid

2012

Hernia

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Section: Dear Editorsmentioning

confidence: 95%

Section: Dear Editorsmentioning

confidence: 99%

Questioning the favorable influence of nerve identification during open inguinal herniorrhaphy is misleading and may increases the risk of surgeons’ liability

Chen

Amid

2012

Hernia

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“…(8) In a study, the rates of chronic pain after 6 months and 5 years were 16.5% and 16.1%, respectively. (29) Ravichandran D et al evaluated the differences in the incidence of pain between the ilioinguinal nerve 'preserved' and 'divided' sides and did not find any significant difference in the pain between both sides. He found that at 6 months postoperatively, pain was present in 5% patients on the nerve preserved side versus 0% on the nerve division side.…”

Section: Discussionmentioning

confidence: 99%

Outcome of Elective Prophylactic Ilioinguinal Neurectomy in Prevention of Chronic Groin Pain After Open Inguinal Hernia Repair

Mattoo¹,

Paul²,

Kachroo³

et al. 2016

jemds

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BACKGROUNDChronic groin pain is one of the most important complications of the repair of inguinal hernia. Randomized trials have identified that chronic groin pain (>10%) surpasses recurrence (<2%). Factors proposed as predictors of post-operative pain are damage to inguinal nerves, nerve entrapment during suturing, fibrosis of the placed material as well as that of surrounding area, mesh implantation, partial division and neuroma formation. Routine ilioinguinal division or excision has been associated with a lower incidence of post-operative neuralgia compared to nerve preservation with reduced morbidity and no detrimental effect on quality of life.

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“…The Reinpold study [17] has now shown that mobilization of the ilioinguinal nerve during open repair causes short term and long term pain with data extending out to ten years. In patients with chronic postherniorrhaphy pain the patient's reoperation to alleviate that pain many times shows evidence of direct injury from suture, tacks, and mesh contraction [18].…”

Section: Discussionmentioning

confidence: 99%

Inguinal Neuritis in Open Recurrent Hernia Repair

Wright¹,

Wright²

2014

IJCM

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PURPOSE: To investigate the pattern of occurrence of inguinal neuritis in recurrent inguinal hernia.We hypothesize that neuritis will occur in more nerves with a wider distribution than in primary repair. METHODS: Retrospective chart review of thirty consecutive recurrent inguinal hernia repairs concentrating on the occurrence of inguinal neuritis. These are not chronic pain patients. Nerves suspected of containing inguinal neuritis were sent for histologic examination. Ilioinguinal nerves were routinely resected. Operative parameters and nerve pathology reports were reviewed. These data were compared with a recent series of one hundred consecutive primary inguinal hernia repairs with a 34% incidence of inguinal neuritis. An independent statistician from Whitman University reviewed the data. RESULTS: Twenty patients were found to have inguinal neuritis among thirty recurrent open inguinal hernia repairs (66%). This compares to 34% among primary repairs, but it is a similar rate (P > 0.42) assuming that the damaged nerve was left intact in 34% of these recurrences during the primary repair. In recurrent inguinal hernia 69% of neuritis occurred in the ilioinguinal nerve compared to 88% of damaged ilioinguinal nerves in the primary hernia. A test for the difference in proportions gives P > 0.10. The most common site of neuritis occurrence in recurrent hernias with nerve damage to the ilioinguinal nerve was at the external oblique neuroperforatum among 70% of patients compared to 83% in primary cases. A test for difference in proportions gives P > 0.36. Two separate nerves were found to exhibit neuritis in six patients (20%) significantly higher than 1% among primary hernias (P < 0.01). CONCLUSION: The overall incidence of inguinal neuritis was 66% in recurrent inguinal hernia repairs. The ilioinguinal nerve was most commonly affected in these recurrent hernias. Inguinal neuritis occurs more commonly in recurrent hernia compared with primary inguinal hernia; however, it has a similar distribution. Neuritis occurs in two nerves with 20% frequency (P < 0.01), so all nerves should be assessed during recurrent herniorrhaphy. The data support the hypothesis.

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Nerve Management and Chronic Pain After Open Inguinal Hernia Repair

Abstract: Mesh contact with a nerve removed from its natural bed may cause chronic long-term pain. The combination of IIN neurolysis and the Lichtenstein repair should be avoided.

Cited by 108 publications

References 40 publications

Questioning the favorable influence of nerve identification during open inguinal herniorrhaphy is misleading and may increases the risk of surgeons’ liability

Questioning the favorable influence of nerve identification during open inguinal herniorrhaphy is misleading and may increases the risk of surgeons’ liability

Outcome of Elective Prophylactic Ilioinguinal Neurectomy in Prevention of Chronic Groin Pain After Open Inguinal Hernia Repair

Inguinal Neuritis in Open Recurrent Hernia Repair

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