Neuropathy After Herniorrhaphy: Indication for Surgical Treatment and Outcome

Abstract

Background Chronic neuropathy after hernia repair is a neglected problem as very few patients are referred for surgical treatment. The aim of the present study was to assess the outcome of standardized surgical revision for neuropathic pain after hernia repair. Methods In a prospective cohort study we evaluated all patients admitted to our tertiary referral center for surgical treatment of persistent neuropathic pain after primary herniorrhaphy between 2001 and 2006. Diagnosis of neuropathic pain was based on clinical findings and a positive Tinel's sign. Postoperative pain was evaluated by a visual analogue scale (VAS) and a pain questionnaire up to 12 months after revision surgery. Results Forty-three consecutive patients (39 male, median age 35 years) underwent surgical revision, mesh removal, and radical neurectomy. The median operative time was 58 min (range: 45-95 min). Histological examination revealed nerve entrapment, complete transection, or traumatic neuroma in all patients. The ilioinguinal nerve was affected in 35 patients (81%); the iliohypogastric nerve, in 10 patients (23%). Overall pain (median VAS) decreased permanently after surgery within a follow-up period of 12 months (preoperative 74 [range: 53-87] months versus 0 [range: 0-34] months; p \ 0.0001). Conclusions The results of this cohort study suggest that surgical mesh removal with ilioinguinal and iliohypogastric neurectomy is a successful treatment in patients with neuropathic pain after hernia repair.

Persistent neuropathic pain after inguinal herniorrhaphy depending on the procedure (open mesh v. laparoscopy): a propensity-matched analysis

“…In patients who experience neuropathic pain and have been reoperated for this reason, examination has revealed not only cases of transection, neuroma or entrapment by sutures, but also entrapment in the fibrosis around the sutured mesh. 31,32 …”

A tailored approach for the treatment of indirect inguinal hernia in adults—an old problem revisited

“…The diagnosis of typical complications was based on clinical symptoms and detailed a detailed examination [19]. In addition, to document the long-term course, all patients were either clinically reassessed or at least asked to answer a standardized questionnaire in 2008.…”

Successful Treatment of Traumatic Neuroma

“…These excellent results, in particular their observations that ''nerves can be difficult to identify where they are entrapped in the scar tissue or in the mesh prosthesis'' [1] as well as ''to prevent nerve scarring within the operative field, the proximal transected nerve ends should be ligated and buried within the fibers of the internal oblique muscle'' [1] are of particular interest to our group, examining the mechanism of traumatic neuroma development. Their results clearly correspond to our hypothesis postulating that traumatic neuroma development involves simultaneous nerve repair and defensive mechanisms (i.e., reactive proliferation of perineurial cells) in the region of concomitant wound and scar contraction [2].…”

“…During a 1-year postoperative follow-up period, 41 patients (95%) experienced complete pain relief, whereas 2 patients noted only partial improvement [1].…”

“…Vuilleumier et al [1] performed a prospective cohort study on 43 consecutive patients who underwent surgical revision, mesh removal, and radical neurectomy as a treatment for persistent neuropathic pain after primary herniorrhaphy. During a 1-year postoperative follow-up period, 41 patients (95%) experienced complete pain relief, whereas 2 patients noted only partial improvement [1].…”