Pain control following inguinal herniorrhaphy: current perspectives

Bjurström, Martin F.; Nicol, Andrea L.; Amid, Parviz K.; Chen, David C.

doi:10.2147/jpr.s47005

Cited by 48 publications

(22 citation statements)

References 125 publications

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“…Systematic reviews published within the last decade have generally found similar predictors for CPIP development. 104 , 146 , 151 , 152 The International Endohernia Society guidelines summarized from the literature: young age, female gender, preoperative pain level, and postoperative pain intensity as risk factors for chronic postoperative pain. 104 One author has summarized risk factors for postherniorrhaphy inguinal pain (Table 3).…”

Section: Pain: Prevention and Treatmentmentioning

confidence: 99%

See 1 more Smart Citation

International guidelines for groin hernia management

Simons¹,

Śmietański²,

Bonjer³

et al. 2018

Hernia

1,552

712

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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%

“…One emphasized the complexity of, and the need for individualization in, treatment schemes making definitive broadly applicable treatment algorithms difficult to compose. 152 The other concluded that while neurectomy provides the best results, improved studies with long-term outcome measures should be initiated. 234 …”

Section: Pain: Prevention and Treatmentmentioning

confidence: 99%

International guidelines for groin hernia management

Simons¹,

Śmietański²,

Bonjer³

et al. 2018

Hernia

1,552

712

View full text Add to dashboard Cite

show abstract

“…One of the applications of TAs is in hernia surgery, where tissue adhesives are used to fix prosthetic materials. The use of sutures for the same purpose, both absorbable and nonabsorbable, has been subject to clinical reviews because some patients report postoperative pain, which has been attributed to nerve entrapment caused by the sutures themselves [ 8 ]. In clinical practice, some authors [ 13 , 25 , 26 ] have reported better comfort and less postoperative pain after hernioplasty using tissue adhesives to fix the mesh.…”

Section: Discussionmentioning

confidence: 99%

“…Sutures have been associated with the appearance of clinical symptoms of pain both in the postoperative period and in the long term, in patients undergoing inguinal hernia [ 6 , 7 ]. The phenomenon of nerve entrapment is among the possible causes of postoperative pain [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

Pre-clinical assay of the tissue integration and mechanical adhesion of several types of cyanoacrylate adhesives in the fixation of lightweight polypropylene meshes for abdominal hernia repair

et al. 2018

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IntroductionLightweight (LW) polypropylene (PP) meshes better adapt to host tissue, causing less fibrosis and inflammatory responses than high-density meshes. Mesh fixation using tissue adhesives (TA) that replace conventional sutures may improve the process of hernia repair and tissue trauma. This preclinical study compares the behavior of different cyanoacrylate-based adhesives in the fixation of LW-PP meshes for hernia repair.MethodsPartial abdominal wall defects were repaired using LW-PP Optilene meshes in New Zealand rabbits. The following groups were established according to the mesh fixation method: Suture (control), Glubran 2 (n-butyl), Ifabond (n-hexyl), SafetySeal (n-butyl) and Evobond (n-octyl). At 14, 90 and 180 days after surgery, the recovered implants were examined to assess the host tissue integration, the macrophage response and the biomechanical strength.ResultsAll the groups showed optimal host tissue incorporation regardless of the fixation procedure. Significantly increased levels of collagen 1 and collagen 3 gene expression (p<0.001) were observed at 14 days compared to the medium- and long-term durations, where the Suture and Glubran groups showed the highest expression of collagen 1. All the adhesives increased the macrophage reaction (p<0.001) compared to sutures at all implant times. Maximal macrophage response was observed in the short-term Glubran group (p<0.01) compared to the rest of the groups. Although SafetySeal and Evobond did not reach the biomechanical resistance of sutures at 14 days, all the adhesives did reach this level in the medium- to long-term periods, providing significantly higher resistance (p<0.05).ConclusionsAll the cyanoacrylates, despite inducing a significantly increased macrophage response versus sutures, showed optimal host tissue integration and long-term mechanical behavior; thus, they might be good choices for LW-PP mesh hernia repairs.

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“…Various methods to reduce the occurrence of inguinodynia have been suggested which include prophylactic ilioinguinal neurectomy, laparoscopic TEP repair, use of lightweight meshes and use of fibrin glue sealant for mesh fixation has been described [19][20][21].…”

Section: Review Of Literaturementioning

confidence: 99%

A Prospective Clinical Study on the Impact of Occupation on Inguinodynia after Inguinal Hernia Repair

Vijayan¹,

Potdar²,

Borle³

et al. 2018

Surgery Curr Res

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Inguinodynia is defined as groin pain at or beyond 3 months following inguinal hernia repair. There is limited literature on this problem from India. Studies have investigated role of different risk factors for inguinodynia like mesh, inguinal nerves identification during surgery, technique of repair etc. However, to our knowledge there is no study on the impact of occupation on inguinodynia.Objective: This study attempts to study the role of occupation in incidence of inguinodynia following surgery.Methods: A prospective study was conducted at a secondary care hospital in Mumbai. 152 adult patients with uncomplicated inguinal hernias who underwent repair by open or laparoscopic technique were enrolled over 2 years. Patients were preoperatively questioned regarding the nature of their occupation and presence of pain associated with inguinal hernia, then divided into five occupation classes depending upon amount of weight lifting involved in their occupation. Postoperatively, they were followed up for 6 months and assessed for inguinodynia by a structured questionnaire. Incidence of inguinodynia was then compared between the different occupation classes.Results: The incidence of inguinodynia at the end of 3rd and 6th month follow-up was 12.10% (19/157 surgeries) and 10.19% (16/157 surgeries) respectively. Incidence of inguinodynia increased from 8.8% for a sedentary worker to 38.5% for an extremely heavyweight worker at 6 months follow-up. By Pearson's Chi-Square test, the p-value was 0.003 which is statistically significant. Conclusion:Thus, the incidence of inguinodynia increased as amount of weight lifting at work increased, suggesting a role of occupation in inguinodynia.

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Pain control following inguinal herniorrhaphy: current perspectives

Cited by 48 publications

References 125 publications

International guidelines for groin hernia management

International guidelines for groin hernia management

Pre-clinical assay of the tissue integration and mechanical adhesion of several types of cyanoacrylate adhesives in the fixation of lightweight polypropylene meshes for abdominal hernia repair

A Prospective Clinical Study on the Impact of Occupation on Inguinodynia after Inguinal Hernia Repair

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