Why do inguinal hernia patients have pain? Histology points to compression neuropathy

Wright, Robert; Born, Donald E.; D'Souza, Natasha; Hurd, Larissa; Gill, R.; Wright, Daniel

doi:10.1016/j.amjsurg.2017.03.013

Cited by 18 publications

(19 citation statements)

References 25 publications

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“…Simultaneously, almost every fifth patient reports moderate to severe pain at rest, whereas while performing a physical activity, the number of patients in this group increases three times (68.1%). Wright et al, who showed changes appearing in the histologic structure of nerves as a result of entrapment neuropathy in patients with preoperative inguinal pain, confirmed a hypothesis regarding this practice [17]. …”

Section: Discussionmentioning

confidence: 92%

Factors influencing inguinal hernia symptoms and preoperative evaluation of symptoms by patients: results of a prospective study including 1647 patients

Mitura

Śmietański

Kozieł³

et al. 2018

Hernia

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BackgroundCurrent recommendations for hernia treatment suggest applying techniques aimed at reducing postoperative pain in patients experiencing intense preoperative pain. However, there is still no reliable stratification method of preoperative pain, its circumstances, intensity and frequency, and the current assessments of hernia symptoms are performed by means of a subjective evaluation. The aim of this work is to discuss preoperative pain before hernia repair and determine its nature depending on the type and length of hernia persistence and the patient’s age.Materials and methodsThe data from 1647 patients before inguinal hernia repairs (2010–2017) were registered prospectively in the National Hernia Repair Register (demographic data, pain score and influence on everyday activities).ResultsThe most common symptom upon admission was pain (949 patients at rest; 57.6% and 1561 at physical activity; 94.8%). A significant influence of hernia persistence on the pain occurrence and intensity was not observed between patients with hernia < 12-months (60.8%;VAS5.0) and > 5-years (58.3%;VAS5.4) (p = 0.068). The occurrence and intensity of pain was significantly higher patients < 40-years (63.7%;VAS5.4) than patients > 60-years (54.3%;VAS4.8) (p = 0.008).ConclusionsWhile pain at rest is not a significant problem, undertaking physical activities may intensify pain and increase the number of patients suffering from it. Preoperative assessment of pain may help determine the group of younger patients who could benefit the most from inguinal hernia repair. New indications for prompter admission for treatment should be planned in future studies of patients showing pain at rest for possible prevention of postoperative neuropathy.

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Section: Discussionmentioning

confidence: 92%

Factors influencing inguinal hernia symptoms and preoperative evaluation of symptoms by patients: results of a prospective study including 1647 patients

Mitura

Śmietański

Kozieł³

et al. 2018

Hernia

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“…In our study, 2.6% of the patients defined their inguinal pain as higher than 3 on the VAS. One reason for this category of pain is the development of permanent injuries in inguinal nerve structure due to pressure caused by a hernia [ 8 ]. In such cases, pain appears before surgery is performed, and postponing surgery may result in an increased risk of developing chronic pain.…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, patients with intense inguinal pain prior to surgery are more susceptible to postoperative chronic pain [ 6 , 7 ]. In such cases, less invasive laparoscopic techniques can be used, allowing atraumatic mesh fixation to reduce postoperative pain [ 8 – 10 ]. These treatments for patients with preoperative pain should minimize upsetting experiences after surgery.…”

mentioning

confidence: 99%

The change in groin pain perception after transabdominal preperitoneal inguinal hernia repair with glue fixation: a prospective trial of a single surgeon’s experience

et al. 2018

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BackgroundAlthough inguinal hernia is one of the most common conditions requiring surgical treatment, no reliable information is available on the quality of life of patients with inguinal hernias before surgery. Additionally, patients with intense inguinal pain prior to surgery are more susceptible to postoperative chronic pain. In such cases, less invasive laparoscopic techniques can be used, allowing atraumatic mesh fixation to reduce postoperative pain. The aim of the study was to determine, whether these treatments for patients with preoperative pain would minimize upsetting experiences after surgery.Materials and methodsData were gathered prospectively from the National Hernia Repair Register for 146 patients who underwent TAPP repairs in the general surgery department (2013–2016). The demographic data were recorded, the pain intensity was determined and patients described the occurrence of pain during ten everyday activities.ResultsThe average surgery time was 56.4 min. The follow-up was 23.4 months. The pain before surgery was 4.28 and 12 months after surgery 0.38 (p < 0.001). Pain intensity before surgery was scored as 4.1, 4.3, and 4.9 among patients who had a hernia < 12 months, > 1 year, and > 5 years, respectively (p = 0.028). Twelve months after surgery, the pain was 0.26, 0.34, and 0.40 (p = 0.037), respectively. Patients < 40 years experienced pain before the surgery more often. The intensity of pre-/postoperative pain was significantly higher < 40 years (4.9/0.63) than > 60 years (3.8/0.29).ConclusionsTAPP inguinal hernia repair with glue fixation significantly decreased the frequency and intensity of the pain compared to that experienced preoperatively. After TAPP repair, the influence of pain on basic everyday activities is substantially lower. Patients under 40 years of age experience frequent and intense pre- and postoperative pain. A longer hernia duration prior to surgery causes increased pre- and postoperative pain.

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“…The pathogenesis of pain has not been clarified until recently when Wright et al. have discovered that gross enlargement of inguinal nerve with specific changes of compression neuropathy has been associated with increased preoperative pain levels, confirmed in 63% of their patients [ 7 ]. This enlargement has been accompanied by fibrosis of the external oblique fascia [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

Prophylaxis and treatment of acute and chronic postoperative inguinal pain (CPIP)—association of pain with compression neuropathy†

Holzheimer

Gaschütz²

2020

Journal of Surgical Case Reports

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Can open inguinal hernia repair (OIHR) and tailored neurectomy (TN) be effective for prophylaxis of chronic postoperative inguinal hernia repair (CPIP) (I) and treatment of CPIP (II)? Patients with symptomatic primary inguinal hernia (I group 1) and secondary hernia with CPIP (II, groups 2–5) were investigated for postoperative complications and nerve damage. About, 98% of patients with OIHR with TN reported preoperative pain (I group 1, n = 388, recurrence rate 1%). There were 73 cases (II) of CPIP after laparoscopic inguinal hernia repair (LIHR) (group 2, n = 22), OIHR (group 3, n = 37), LIHR followed by OIHR/LIHR (group 4, n = 5) and OIHR followed by LIHR/OIHR (group 5, n = 9). The results were as follows: preoperative pain: 33–100%, recurrence rate 0–11% (II, groups 2–5), nerve damage 92–100% and persistent CPIP: n = 1 after trocar perforation of inguinal nerve elsewhere. OIHR is effective to avoid CPIP with compression neuropathy. This is the largest series of histological nerve damage in CPIP.

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Why do inguinal hernia patients have pain? Histology points to compression neuropathy

Cited by 18 publications

References 25 publications

Factors influencing inguinal hernia symptoms and preoperative evaluation of symptoms by patients: results of a prospective study including 1647 patients

Factors influencing inguinal hernia symptoms and preoperative evaluation of symptoms by patients: results of a prospective study including 1647 patients

The change in groin pain perception after transabdominal preperitoneal inguinal hernia repair with glue fixation: a prospective trial of a single surgeon’s experience

Prophylaxis and treatment of acute and chronic postoperative inguinal pain (CPIP)—association of pain with compression neuropathy†

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