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Laparoscopic Approaches to Chronic Postoperative Inguinal Pain

  • David K. Nguyen
  • David C. Chen
Chapter

Abstract

Chronic postoperative inguinal pain refractory to medical management is a challenging condition with significant costs and impact on a patient’s quality of life and limited options for remediation and pain relief. Laparoscopic approaches to inguinal neurectomy are a valuable, highly effective adjunct in dealing with neuropathic postoperative inguinal pain. Safe and effective mesh removal may be facilitated by laparoscopic or hybrid techniques that allow for greater visualization and dissection of mesh from the posterior wall. Orchialgia may be improved with laparoscopic paravasal neurectomy. There is no one size fits all, as each approach needs to be tailored to the patient’s initial repair, pain symptoms and distribution, physical exam, imaging, and shared decision-making. A solid understanding of the anterior and posterior anatomy, mechanisms of injury, and laparoscopic and open routes to access pathology provides a broad range of options to tailor treatment and improve outcomes.

References

  1. 1.
    Reinpold WM, Nehls J, Eggert A. Nerve management and chronic pain after open inguinal hernia repair: a prospective two phase study. Ann Surg. 2011;254(1):163–8.CrossRefPubMedGoogle Scholar
  2. 2.
    Kehlet H. Chronic pain after groin hernia repair. Br J Surg. 2008;95(2):135–6.CrossRefPubMedGoogle Scholar
  3. 3.
    Bjurstrom MF, Nicol AL, Amid PK, et al. Pain control following inguinal herniorrhaphy: current perspectives. J Pain Res. 2014;7:277–90.PubMedPubMedCentralGoogle Scholar
  4. 4.
    Lange JFM, Kaufmann R, Wijsmuller AR, et al. An international consensus algorithm for management of chronic post-operative inguinal pain. Hernia. 2015;19:33–43.CrossRefPubMedGoogle Scholar
  5. 4.
    Campanelli G, Bertocchi V, Cavalli M, et al. Surgical treatment of chronic pain after inguinal hernia repair. Hernia. 2013;17:347–53.CrossRefPubMedGoogle Scholar
  6. 5.
    Werner MU. Management of persistent postsurgical inguinal pain. Langenbeck’s Arch Surg. 2014;399:559–69.CrossRefGoogle Scholar
  7. 6.
    Stulz P. Peripheral nerve injuries resulting from common surgical procedures in the lower portion of the abdomen. Arch Surg. 1982;117:324–7.CrossRefPubMedGoogle Scholar
  8. 7.
    Aasvang E, Kehlet H. Surgical management of chronic pain after inguinal hernia repair. Br J Surg. 2005;92(7):795–801.CrossRefPubMedGoogle Scholar
  9. 8.
    Bay-Nielsen M, Perkins FM, Kehlet H, Danish Hernia Database. Pain and functional impairment 1 year after inguinal herniorrhaphy: a nationwide questionnaire study. Ann Surg. 2001;233(1):1–7.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 9.
    Amid PK. Radiologic images of meshoma: a new phenomenon causing chronic pain after prosthetic repair of abdominal wall hernias. Arch Surg. 2004;139(12):1297–8.CrossRefPubMedGoogle Scholar
  11. 10.
    Lichtenstein IL, Shulman AG, Amid PK, Montllor MM. Cause and prevention of postherniorrhaphy neuralgia: a proposed protocol for treatment. Am J Surg. 1988;155(6):786–90.CrossRefPubMedGoogle Scholar
  12. 11.
    Amid PK, Hiatt JR. New understanding of the causes and surgical treatment of postherniorrhaphy inguinodynia and orchalgia. J Am Coll Surg. 2007;205(2):381–5.CrossRefPubMedGoogle Scholar
  13. 12.
    Heise CP, Starling JR. Mesh inguinodynia: a new clinical syndrome after herniorrhaphy? J Am Coll Surg. 1998;187(5):514–8.CrossRefPubMedGoogle Scholar
  14. 13.
    Amid PK. A 1-stage surgical treatment for postherniorrhaphy neuropathic pain: triple neurectomy and proximal end implantation without mobilization of the cord. Arch Surg. 2002;137:100–4.PubMedGoogle Scholar
  15. 14.
    Starling J, Harms B, Schroeder M, et al. Diagnosis and treatment of genitofemoral and ilioinguinal entrapment neuralgia. Surgery. 1987;102:581–6.PubMedGoogle Scholar
  16. 15.
    Madura JA, Copper CM, Worth RM. Inguinal neurectomy for inguinal nerve entrapment: an experience with 100 patients. Am J Surg. 2005;189:283–7.CrossRefPubMedGoogle Scholar
  17. 16.
    Rab M, Ebmer And J, Dellon AL. Anatomic variability of the ilioinguinal and genitofemoral nerve: implications for the treatment of groin pain. Plast Reconstr Surg. 2001;108(6):1618–23.CrossRefPubMedGoogle Scholar
  18. 17.
    Klaassen Z, Marshall E, Tubbs RS, Louis RG Jr, et al. Anatomy of the ilioinguinal and iliohypogastric nerves with observations of their spinal nerve contributions. Clin Anat. 2011;24(4):454–61.CrossRefPubMedGoogle Scholar
  19. 18.
    Bischoff JM, Enghuus C, Werner MU, et al. Long-term follow-up after mesh removal and selective neurectomy for persistent inguinal postherniorrhaphy pain. Hernia. 2013;17:339–45.CrossRefPubMedGoogle Scholar
  20. 19.
    Valvekens E, Nijs Y, Miserez M. Long-term outcome of surgical treatment of chronic postoperative groin pain: a word of caution. Hernia. 2015;19:587–94.CrossRefPubMedGoogle Scholar
  21. 20.
    Lee CH, Dellon AL. Surgical management of groin pain of neural origin. J Am Coll Surg. 2000;191:137–42.CrossRefPubMedGoogle Scholar
  22. 21.
    Giger U, Wente MN, Büchler MW, et al. Endoscopic retroperitoneal neurectomy for chronic pain after groin surgery. Br J Surg. 2009;96:1076–81.CrossRefPubMedGoogle Scholar
  23. 22.
    Chen DC, Hiatt JR, Amid PK. Operative management of refractory neuropathic inguinodynia by a laparoscopic retroperitoneal approach. JAMA Surg. 2013;148:962–7.CrossRefPubMedGoogle Scholar
  24. 23.
    Moreno-Egea A. Surgical management of postoperative chronic inguinodynia by transabdominal preperitoneal approach. Surg Endosc. 2016;30(12):5222–7.CrossRefPubMedGoogle Scholar
  25. 24.
    Bjurstrom FM, Nicol AL, Amid PK, et al. Neurophysiological and clinical effects of laparoscopic retroperitoneal triple neurectomy in patients with refractory postherniorrhaphy neuropathic inguinodynia. Pain Pract. 2016;17(4):447–59.CrossRefPubMedGoogle Scholar
  26. 25.
    Reinpold W, Schroeder AD, Schroeder M, et al. Retroperitoneal anatomy of the iliohypogastric, ilioinguinal, genitofemoral, and lateral femoral cutaneous nerve: consequences for prevention and treatment of chronic inguinodynia. Hernia. 2015;19:539–48.CrossRefPubMedGoogle Scholar
  27. 26.
    Moore AM, Bjurstrom MF, Hiatt JR, et al. Efficacy of retroperitoneal triple neurectomy for refractory neuropathic inguinodynia. Am J Surg. 2016;212:1126–32.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Lichtenstein Amid Hernia Clinic at UCLALos AngelesUSA

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