Groin anatomy, preoperative pain, and compression neuropathy in primary inguinal hernia: What really matters

Wright, Robert; Salisbury, Troy; Landes, Jordan

doi:10.1016/j.amjsurg.2019.02.017

Cited by 11 publications

(13 citation statements)

References 13 publications

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“…Considered along with the intraoperative findings, these results suggest that severe neuropathy was induced by chronic compression of ilioinguinal nerves due to a bulky spermatic cord lipoma in case 1 and inguinal hernia presenting over a few decades in case 2 . These findings are in line with previous studies reporting that compression of the ilioinguinal nerve by the external inguinal ring was involved in painful inguinal hernia [8] , [9] , [10] .…”

Section: Discussionsupporting

confidence: 93%

A pathological perspective to painful inguinal hernia: Report of two cases

Narita

Moriyoshi

Goto

et al. 2021

International Journal of Surgery Case Reports

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Introduction Preoperative inguinal pain (painful inguinal hernia) is a well-known factor associated with chronic postoperative inguinal pain (CPIP). However, it remains unclear what preventive measures should be taken in such patients. Case presentation We report two patients with painful inguinal hernia who underwent pragmatic ilioinguinal nerve neurectomy during open anterior repair. The nerve was compressed by bulky spermatic cord lipoma in case 1 and by the hernia sac presenting over a few decades in case 2. Hematoxylin and eosin staining of the resected nerves revealed mucoid degeneration. Toluidine blue staining of resin-embedded nerve sections demonstrated that fully-myelinated axons had significantly decreased in case 1 and almost disappeared in case 2, indicating the development of massive demyelination of the ilioinguinal nerve in both cases. Discussion In cases where the injured nerve is left in situ, CPIP may occur since demyelinating neuropathy sometimes becomes irreversible. Conclusion Planned nerve resection via open anterior inguinal hernia repair may be an option to prevent CPIP in patients with painful inguinal hernia.

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Section: Discussionsupporting

confidence: 93%

A pathological perspective to painful inguinal hernia: Report of two cases

Narita

Moriyoshi

Goto

et al. 2021

International Journal of Surgery Case Reports

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“…Most authors focus on preoperative pain in relation to the II nerve. A recent prospective study supported the hypothesis that preoperative pain can be due to compression neuropathy on the II nerve, with its enlargement in correspondence of the external inguinal ring [31]. The same authors did not find any significant relation between preoperative pain and the type of hernia, or the course of the IH and II nerves [31].…”

Section: Discussionmentioning

confidence: 85%

Dermatome Mapping Test in the analysis of anatomo-clinical correlations after inguinal hernia repair

et al. 2020

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Background Nerve identification is recommended in inguinal hernia repair to reduce or avoid postoperative pain. The aim of this prospective observational study was to identify nerve prevalence and find a correlation between neuroanatomy and chronic neuropathic postoperative inguinal pain (CPIP) after 6 months. Material A total of 115 patients, who underwent inguinal hernia mesh repair (Lichtenstein tension-free mesh repair) between July 2018 and January 2019, were included in this prospective observational study. The mean age and BMI respectively resulted 64 years and 25.8 with minimal inverse distribution of BMI with respect to age. Most of the hernias were direct (59.1%) and of medium dimension (47.8%). Furthermore, these patients were undergoing Dermatome Mapping Test in preoperatively and postoperatively 6 months evaluation. Results Identification rates of the iliohypogastric (IH), ilioinguinal (II) and genitofemoral (GF) nerves were 72.2%, 82.6% and 48.7% respectively. In the analysis of nerve prevalence according to BMI, the IH was statistically significant higher in patients with BMI < 25 than BMI ≥ 25 P (< 0.05). After inguinal hernia mesh repair, 8 patients (6.9%) had chronic postoperative neuropathic inguinal pain after 6 months. The CPIP prevailed at II/GF dermatome. The relation between the identification/neurectomy of the II nerve and chronic postoperative inguinal pain after 6 months was not significant (P = 0.542). Conclusion The anatomy of inguinal nerve is very heterogeneous and for this reason an accurate knowledge of these variations is needed during the open mesh repair of inguinal hernias. The new results of our analysis is the statistically significant higher IH nerve prevalence in patients with BMI < 25; probably the identification of inguinal nerve is more complex in obese patients. In the chronic postoperative inguinal pain, the II nerve may have a predominant role in determining postoperative long-term symptoms. Dermatome Mapping Test in an easy and safe method for preoperative and postoperative 6 months evaluation of groin pain. The most important evidence of our analysis is that the prevalence of chronic pain is higher when the nerves were not identified.

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“…Durante los últimos años se han identificados numerosos factores predictivos: un amplio metanálisis que incluía a 53.362 pacientes de 33 publicaciones estudió el impacto e los factores preoperatorios en los resultados postoperatorios (9). Nueve variables alcanzaron una significancia estadística: edad joven, sexo femenino, hábito tabáquico, índice de masa corporal elevado, presencia de dolor preoperatorio y el uso de analgesia preoperatoria.…”

Section: Discussionunclassified