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Magnetic resonance imaging has no role in diagnosing the origin of pain in patients with overwhelmingly painful inguinal hernia

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Abstract

Purpose

Clinical tools for predicting postoperative pain should be developed to provide better care for patients. The aims of this study were to evaluate preoperative magnetic resonance imaging (MRI) findings to reveal reasons for overwhelming pain in patients with inguinal hernia and to detect changes in quality-of-life (QoL) and pain scores preoperatively and following laparoscopic totally extraperitoneal (TEP) repair of inguinal hernia.

Methods

Twenty-two patients aged 18–50 years presenting with extremely painful inguinal hernias (highest pain scores >50, scale 0–100) were examined with MRI prior to operative treatment with TEP repair. Postoperative follow-up lasted 6 months and consisted of questionnaires regarding functional status, pain, QoL and possible complications. Postoperative MRI scans were performed only in cases of preoperative findings on the MRI or prolonged inguinal pain persisting over 6 months.

Results

Prolonged postoperative pain could not be predicted from preoperative MRI scans, because no signs of the pain’s origin such as pubic periostal irritation, bone marrow edema, pelvic bone or hip joint abnormalities, or lower abdominal muscle hemorrhage were detected in MRI. TEP repair of inguinal hernia significantly improved the patients’ quality of life and relieved pain symptoms. High preoperative pain scores were major predictors of prolonged postoperative pain.

Conclusions

Carefully evaluated preoperative pelvic MRI was usually normal in patients with high pain scores prior to operation. Preoperative pain scores may serve as indicators of development of prolonged inguinal pain.

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Conflict of interest

S.K. declares receiving a grant from the Finnish government funding for clinical research at North Karelia Central Hospital (EVO) and no other conflict of interest that directly relates to this study. S.S., J.K., T.H. and H.P. declare no conflicts of interest that directly relate to this study.

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Authors and Affiliations

  1. Department of Surgery, North Karelia Central Hospital, Joensuu, Finland

    S. Kouhia, S. Silvasti & T. Hakala

  2. Department of Surgery, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland

    S. Kouhia & H. Paajanen

  3. Medical Imaging Center, Joint Municipality of Authority for Medical and Social Services in North Karelia, Joensuu, Finland

    J. Kainulainen

Authors
  1. S. Kouhia
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  2. S. Silvasti
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  3. J. Kainulainen
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  4. T. Hakala
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  5. H. Paajanen
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Correspondence to S. Kouhia.

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Kouhia, S., Silvasti, S., Kainulainen, J. et al. Magnetic resonance imaging has no role in diagnosing the origin of pain in patients with overwhelmingly painful inguinal hernia. Hernia 19, 557–563 (2015). https://doi.org/10.1007/s10029-015-1374-5

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  • DOI: https://doi.org/10.1007/s10029-015-1374-5

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