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Chronic Pain After Inguinal Repair

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Management of Abdominal Hernias

Abstract

Chronic postherniorrhaphy inguinal pain (CPIP) has surpassed recurrence as the most common severe long-term complication of inguinal hernia surgery. The etiologies of CPIP are variable and incompletely understood, but evidence is emerging to guide the prevention and management of this debilitating syndrome. Meticulous attention to preoperative risk factors, intraoperative nerve identification, and postoperative analgesic care can help minimize risk for CPIP. If a patient develops signs and symptoms of CPIP, the clinician should apply a stepwise approach to diagnosis of the root cause of pain. Patients should be evaluated and treated by a multidisciplinary team including a pain specialist with pharmacologic, behavioral, and interventional modalities. Not all patients with severe pain following inguinal hernia repair are reasonable candidates for operative intervention. For patients with findings that suggest a lesion that would be amenable to surgical correction, open or laparoscopic triple neurectomy has been shown to be efficacious. Intimate familiarity with groin neuroanatomy is crucial to performing these operations successfully. Proper management of chronic inguinodynia following groin surgery can markedly improve ability to work, opiate dependence, and quality of life for patients who develop this complex and challenging syndrome.

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Author information

Authors and Affiliations

  1. Residency in General Surgery, Vanderbilt University Medical Center, Nashville, TN, USA

    Nicholas H. Carter MD

  2. Lichtenstein Amid Hernia Clinic at UCLA, Santa Monica, CA, USA

    David C. Chen MD

  3. Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA

    David C. Chen MD

Authors
  1. Nicholas H. Carter MD
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  2. David C. Chen MD
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Correspondence to David C. Chen MD .

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Editors and Affiliations

  1. Surgeons Group of Baton Rouge of Our Lady of the Lake Physician Group, Baton Rouge, Louisiana, USA

    Karl A. LeBlanc

  2. Peninsula College of Medicine and Dentistry (Emeritus), Plymouth, United Kingdom

    Andrew Kingsnorth

  3. North Devon District Hospital, Barnstaple, United Kingdom

    David L. Sanders

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Carter, N.H., Chen, D.C. (2018). Chronic Pain After Inguinal Repair. In: LeBlanc, K., Kingsnorth, A., Sanders, D. (eds) Management of Abdominal Hernias. Springer, Cham. https://doi.org/10.1007/978-3-319-63251-3_23

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  • DOI: https://doi.org/10.1007/978-3-319-63251-3_23

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