Surgical Endoscopy

, Volume 32, Issue 3, pp 1613–1619 | Cite as

Laparoscopic mesh removal for otherwise intractable inguinal pain following endoscopic hernia repair is feasible, safe and may be effective in selected patients

  • G. D. Slooter
  • W. A. R. Zwaans
  • C. W. Perquin
  • R. M. H. Roumen
  • M. R. M. Scheltinga
New Technology

Abstract

Background

Laparoscopic inguinal hernia repair is preferred over an open technique because of reduced recovery time, favorable cost effectiveness, and less chronic postoperative inguinal pain. Nevertheless, some patients develop a nociceptive inguinal pain syndrome possibly related to the presence of the mesh. This is the first study describing feasibility, safety, and effectiveness of laparoscopic mesh removal in patients with chronic pain after endoscopic hernia repair.

Methods

Pre- and intraoperative data of chronic pain patients scheduled for endoscopic mesh removal were prospectively collected by a standard evaluation form. Long-term efficacy was determined using pain scores, patient satisfaction, and quality of life questionnaire. A Wilcoxon signed-rank test was used to determine significant differences between pre- and postoperative pain scores.

Results

Fourteen patients were studied (11 males, median 52 years). Median operating time was 103 min. Conversion to open surgery was not required. One intraoperatively recognized bladder laceration was laparoscopically closed. Otherwise, no intraoperative or postoperative complications occurred. Eight months postoperatively (median), pain scores had dropped from eight to four (p < 0.01). Satisfaction was good or excellent in ten patients. A recurrent hernia developed in two patients requiring an open mesh repair in one.

Conclusions

Laparoscopic mesh removal is a feasible, safe, and effective option in selected patients with chronic groin pain after endoscopic hernia repair in the hands of an experienced surgeon.

Keywords

Hernia, inguinal Chronic pain Pain Postoperative Herniorrhaphy Surgical mesh Laparoscopy 

Notes

Compliance with ethical standards

Disclosure

Gerrit D. Slooter, Willem A.R. Zwaans, Christel W. Perquin, Rudi M.H. Roumen and Marc R.M. Scheltinga have no conflicts of interest or financial ties to disclose.

References

  1. 1.
    Kingsnorth A, LeBlanc K (2003) Hernias: inguinal and incisional. Lancet 362(9395):1561–1571CrossRefPubMedGoogle Scholar
  2. 2.
    Simons MP, Smietanski M, Bonjer HJ et al (2016) World guidelines for groin hernia management. The HerniaSurge Group, LondonGoogle Scholar
  3. 3.
    Tschuor C, Metzger J, Clavien PA et al (2015) Inguinal hernia repair in Switzerland. Hernia 19(5):741–745CrossRefPubMedGoogle Scholar
  4. 4.
    Koning GG, Wetterslev J, van Laarhoven CJ et al (2013) The totally extraperitoneal method versus Lichtenstein’s technique for inguinal hernia repair: a systematic review with meta-analyses and trial sequential analyses of randomized clinical trials. PLoS ONE 8(1):e52599CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Perkins FM, Kehlet H (2000) Chronic pain as an outcome of surgery. A review of predictive factors. Anesthesiology 93(4):1123–1133CrossRefPubMedGoogle Scholar
  6. 6.
    Nienhuijs S, Staal E, Strobbe L et al (2007) Chronic pain after mesh repair of inguinal hernia: a systematic review. Am J Surg 194(3):394–400CrossRefPubMedGoogle Scholar
  7. 7.
    Simons MP, Aufenacker T, Bay-Nielsen M et al (2009) European hernia society guidelines on the treatment of inguinal hernia in adult patients. Hernia 13(4):343–403CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Aasvang E, Kehlet H (2005) Chronic postoperative pain: the case of inguinal herniorrhaphy. Br J Anaesth 95(1):69–76CrossRefPubMedGoogle Scholar
  9. 9.
    Grant AM, Scott NW, O’Dwyer PJ (2004) Five-year follow-up of a randomized trial to assess pain and numbness after laparoscopic or open repair of groin hernia. Br J Surg 91(12):1570–1574CrossRefPubMedGoogle Scholar
  10. 10.
    Zwaans WA, Perquin CW, Loos MJ et al (2017) Mesh removal and selective neurectomy for persistent groin pain following Lichtenstein repair. World J Surg 41(3):701–712CrossRefPubMedGoogle Scholar
  11. 11.
    Ware J Jr, Kosinski M, Keller SD (1996) A 12-item short-form health survey: construction of scales and preliminary tests of reliability and validity. Med Care 34(3):220–233CrossRefPubMedGoogle Scholar
  12. 12.
    Amid PK (2004) Radiologic images of meshoma: a new phenomenon causing chronic pain after prosthetic repair of abdominal wall hernias. Arch Surg 139(12):1297–1298CrossRefPubMedGoogle Scholar
  13. 13.
    Ohkura Y, Haruta S, Shinohara H et al (2015) Laparoscopic plug removal for femoral nerve colic pain after mesh & plug hernioplasty. BMC Surg 15:64CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Keller JE, Stefanidis D, Dolce CJ et al (2008) Combined open and laparoscopic approach to chronic pain after inguinal hernia repair. Am Surg 74(8):695–700PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • G. D. Slooter
    • 1
  • W. A. R. Zwaans
    • 1
    • 2
  • C. W. Perquin
    • 1
  • R. M. H. Roumen
    • 1
    • 2
  • M. R. M. Scheltinga
    • 1
    • 2
  1. 1.Department of General SurgeryMáxima Medical CentreVeldhoven/EindhovenThe Netherlands
  2. 2.SolviMáx, Center of Expertise for ACNES, Center of Excellence for Chronic Abdominal Wall and Groin PainEindhovenThe Netherlands

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