New Understanding of the Causes and Surgical Treatment of Postherniorrhaphy Inguinodynia and Orchialgia

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

“…A recent judgment for $8.2 million dollars for disability caused by a suture identified on the ilioinguinal nerve is an excessive example of the liability placed upon the surgeon to prevent this injury [10]. We are in complete agreement with the authors that chronic pain is multifactorial and a host of other causes in addition to neuropathy make definition, diagnosis, management, and treatment a challenge [1,[3][4][5]. However, an emphasis on proper nerve identification, nerve handling, and technique can help to reduce the incidence of this problem.…”

“…It is well known to hernia surgeons that chronic pain has a multifactorial etiology and may develop after hernia operations despite careful handling of nerves and meticulous surgical technique [1,[3][4][5]. In 2008, the International Consensus Conference was held in Rome with a working group of nine hernia experts and an audience of 200 participants-a group well known to both the authors of this manuscript and the reviewers.…”

Three-month results of the effect of Ultrapro or Prolene mesh on post-operative pain and well-being following endoscopic totally extraperitoneal hernia repair (TULP trial)

“…First, there is a reduced risk of direct nerve damage when working in the preperitoneal space in comparison with open anterior repair. Second, the preperitoneal as a barrier consists of two layers (parietal and visceral) separated by a thin fascia [40]. The large sensory nerves are located behind this fascia in the parietal space.…”

Neurophysiological and Clinical Effects of Laparoscopic Retroperitoneal Triple Neurectomy in Patients with Refractory Postherniorrhaphy Neuropathic Inguinodynia

“…In open anterior inguinal hernia repair (methods of Lichtenstein, Bassini, McVay, or Shouldice), all 3 of the inguinal nerves are at risk and may be injured either through direct trauma, entrapment by fixation, mesh, or scar, or subsequent inflammation . In open posterior repair with mesh placed in the preperitoneal space (prolene hernia system, ultrapro hernia system, plug, Kugel, transrectus preperitoneal procedure, transinguinal preperitoneal procedure), the inguinal nerves are at risk in the inguinal canal in addition to the genitofemoral nerve (GFN) trunk or its individual genital or femoral branches in the preperitoneal space.…”

“…In open anterior inguinal hernia repair (methods of Lichtenstein, Bassini, McVay, or Shouldice), all 3 of the inguinal nerves are at risk and may be injured either through direct trauma, entrapment by fixation, mesh, or scar, or subsequent inflammation. 5,6 In open posterior repair with mesh placed in the preperitoneal space (prolene hernia system, ultrapro hernia system, plug, Kugel, transrectus preperitoneal procedure, transinguinal preperitoneal procedure), the inguinal nerves are at risk in the inguinal canal in addition to the genitofemoral nerve (GFN) trunk or its individual genital or femoral branches in the preperitoneal space. After laparoscopic inguinal hernia repair using fixating devices (tacks or sutures), pain may be related to injury of one or all inguinal nerves caused by penetrating fixation through the transversalis fascia and floor of the inguinal canal in addition to potential injury to the preperitoneal GFN trunk or its branches or the lateral femoral cutaneous (LFC) nerve in the retroperitoneum requiring proximal triple neurectomy.…”