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Chronic Postoperative Inguinal Pain (CPIP)

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Abstract

It is well established that almost every surgical intervention may lead to chronic pain. According to published trials with systematic data collection, the highest chronic pain rates are reported after leg amputation, thoracotomy, and breast surgery with 60%, 50%, and 30%, respectively [1].

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References

  1. Aasvang E, Kehlet H. Chronic postoperative pain: the case of inguinal herniorrhaphy. Br J Anaesth. 2005;95(1):69–76.

    Article  CAS  PubMed  Google Scholar 

  2. Amid PK. Causes, prevention, and surgical treatment of postherniorrhaphy neuropathic inguinodynia: triple neurectomy with proximal end implantation. Hernia. 2004;8(4):343–9.

    Article  CAS  PubMed  Google Scholar 

  3. Harms BA, DeHaas DR Jr, Starling JR. Diagnosis and management of genitofemoral neuralgia. Arch Surg. 1984;119(3):339–41.

    Article  CAS  PubMed  Google Scholar 

  4. Cunningham J, Temple WJ, Mitchell P, Nixon JA, Preshaw RM, Hagen NA. Cooperative hernia study. Pain in the postrepair patient. Ann Surg. 1996;224(5):598–602.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Kehlet H, Roumen RM, Reinpold W, Miserez M. Invited commentary: persistent pain after inguinal hernia repair: what do we know and what do we need to know? Hernia. 2013;17(3):293–7. https://doi.org/10.1007/s10029-013-1109-4. Epub 2013 May 21.

    Article  PubMed  CAS  Google Scholar 

  6. Bittner R, Montgomery MA, Reinpold W, Arregui E, Bansal V, Bingener J, Bisgaard T, Buhck H, Dudai M, Ferzli GS, Fitzgibbons RJ, Fortelny RH, Grimes KL, Klinge U, Köckerling F, Kumar S, Kukleta J, Lomanto D, Misra MC, Morales-Conde S, Rosenberg J, Singh K, Timoney M, Weyhe D, Chowbey P. International Endohernia society. Update of guidelines on laparoscopic (TAPP) and endoscopic (TEP) treatment of inguinal hernia (international Endohernia society). Surg Endosc. 2015;29(2):289–321. Epub 2014 Nov 15.

    Article  CAS  PubMed  Google Scholar 

  7. Bittner R, Arregui ME, Reinpold W, Bisgaard T, Buhck H, Dudai M, Ferzli GS, Fitzgibbons RJ, Fortelny RH, Grimes KL, Klinge U, Köckerling F, Kumar S, Kukleta J, Lomanto D, Misra MC, Morales-Conde S, Rosenberg J, Singh K, Timoney M, Weyhe D. Chowbey pet al. Guidelines for laparoscopic (TAPP) and endoscopic (TEP) treatment of inguinal hernia [international Endohernia society (IEHS)]. Surg Endosc. 2011;25(9):2773–843. https://doi.org/10.1007/s00464-011-1799-6.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  8. Nienhuijs S, Staal E, Keemers-Gels M, Rosman C, Strobbe L. Pain after open preperitoneal repair versus Lichtenstein repair: a randomized trial. World J Surg 2007;31(9):1751–7; discussion 1758–9. https://doi.org/10.1007/s00268-007-9090-7.

    Article  PubMed  Google Scholar 

  9. Bay-Nielsen M, Perkins FM, Kehlet H. Pain and functional impairment 1 year after inguinal herniorrhaphy: a nationwide questionnaire study. Ann Surg. 2001;233(1):1–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Aasvang EK, Bay-Nielsen M, Kehlet H. Pain and functional impairment 6 years after inguinal herniorrhaphy. Hernia. 2006;10(4):316–21.

    Article  CAS  PubMed  Google Scholar 

  11. Kalliomäki ML, Meyerson J, Gunnarsson U, Gordh T, Sandblom G. Long-term pain after inguinal hernia repair in a population-based cohort; risk factors and interference with daily activities. Eur J Pain. 2008;12(2):214–25.

    Article  PubMed  Google Scholar 

  12. 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.

    Article  PubMed  Google Scholar 

  13. Alfieri S, Amid PK, Campanelli G, Izard G, Kehlet H, Wijsmuller AR, Di Miceli D, Doglietto GB. International guidelines for prevention and management of post-operative chronic pain following inguinal hernia surgery. Hernia. 2011;15:239–49.

    Article  CAS  PubMed  Google Scholar 

  14. Association for the study of pain. Classification of chronic pain. Description of pain terms. Prepared by the international association for the study of pain, subcommittee on taxonomy. Pain Suppl. 1986;(3):1–226.

    Google Scholar 

  15. Aasvang E, Mohl B, Kehlet H. Ejaculatory pain: a specific postherniotomy pain syndrome? Anesthesiology. 2007;107(2):298–304.

    Article  PubMed  Google Scholar 

  16. Bischoff J, Linderoth G, Aasvang E, Werner M, Kehlet H. Dysejaculation after laparoscopic inguinal herniorrhaphy: a nationwide questionnaire study. Surg Endosc. 2012;26(4):979–83.

    Article  PubMed  Google Scholar 

  17. Amid PK, Hiatt J. New understanding of the causes and surgical treatment of postherniorrhaphy inguinodynia and orchalgia. J Am Coll Surg. 2007;205:381–5.

    Article  PubMed  Google Scholar 

  18. McCormack K, Scott NW, Go PM, Ross S, Grant AM. Laparoscopic techniques versus open techniques for inguinal hernia repair. Cochrane Database Syst Rev. 2003;(1):CD001785. https://doi.org/10.1002/14651858.CD001785.

  19. Schmedt CG, Sauerland S, Bittner R. Comparison of endoscopic procedures vs Lichtenstein and other open mesh techniques for inguinal hernia repair: a meta-analysis of randomized controlled trials. Surg Endosc. 2005;19(2):188–99. https://doi.org/10.1007/s00464-004-9126-0.

    Article  CAS  PubMed  Google Scholar 

  20. McCormack K, Scott NW, Go PM, Ross S, Grant AM, Collaboration EUHT. Laparoscopic techniques versus open techniques for inguinal hernia repair. Cochrane Database Syst Rev. 2003;(1):CD001785.

    Google Scholar 

  21. Bittner R, Sauerland S, Schmedt C-G. Comparison of endoscopic techniques vs Shouldice and other open nonmesh techniques for inguinal hernia repair: a meta-analysis of randomized controlled trials. Surg Endosc. 2005;19(5):605–15. https://doi.org/10.1007/s00464-004-9049-9.

    Article  PubMed  CAS  Google Scholar 

  22. Grant A. Laparoscopic compared with open methods of groin hernia repair: systematic review of randomized controlled trials. Br J Surg. 2000;87:860–7. https://doi.org/10.1046/j.1365-2168.2000.01540.x.

  23. Li J, Ji Z, Cheng T. Comparison of open preperitoneal and Lichtenstein repair for inguinal hernia repair: a meta-analysis of randomized controlled trials. Am J Surg. 2012;204:769–78. https://doi.org/10.1016/j.amjsurg.2012.02.010.

    Article  PubMed  Google Scholar 

  24. Alfieri S, Rotondi F, Di Giorgio A, et al. Influence of preservation versus division of ilioinguinal, iliohypogastric, and genital nerves during open mesh herniorrhaphy: prospective multicentric study of chronic pain. Ann Surg. 2006;243(4):553–8.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Wijsmuller AR, Van Veen RN, Bosch JL, et al. Nerve management during open hernia repair. Br J Surg. 2007;94(1):17–22. https://doi.org/10.1002/bjs.5651.

    Article  PubMed  CAS  Google Scholar 

  26. Hsu W, Chen C-S, Lee H-C, et al. Preservation versus division of ilioinguinal nerve on open mesh repair of inguinal hernia: a meta-analysis of randomized controlled trials. World J Surg. 2012;36(10):2311–9. https://doi.org/10.1007/s00268-012-1657-2.

    Article  PubMed  Google Scholar 

  27. Johner A, Faulds J, Wiseman SM. Planned ilioinguinal nerve excision for prevention of chronic pain after inguinal hernia repair: a meta-analysis. Surgery. 2011;150(3):534–41. https://doi.org/10.1016/j.surg.2011.02.024.

    Article  PubMed  Google Scholar 

  28. Smeds S, Löfström L, Eriksson O. Influence of nerve identification and the resection of nerves “at risk” on postoperative pain in open inguinal hernia repair. Hernia. 2010;14(3):265–70. https://doi.org/10.1007/s10029-010-0632-9.

    Article  PubMed  CAS  Google Scholar 

  29. Bartlett DC, Porter C, Kingsnorth A. A pragmatic approach to cutaneous nerve division during open inguinal hernia repair. Hernia. 2007;11(3):243–6. https://doi.org/10.1007/s10029-007-0209-4.

    Article  PubMed  CAS  Google Scholar 

  30. Reinpold W, Schroeder AD, Schroeder M, Berger C, Rohr M, Wehrenberg U. Retroperitoneal anatomy of the iliohypogastric, ilioinguinal, genitofemoral, and lateral femoral cutaneous nerve: consequences for prevention and treatment of chronic inguinodynia. Hernia. 2015;19(4):539–48. https://doi.org/10.1007/s10029-015-1396-z. Epub 2015 Jun 17.

    Article  CAS  PubMed  Google Scholar 

  31. Alvarez R. Dermatome mapping: preoperative and postoperative assessment. SAGES manual of groin pain. New York: Cham Springer; 2016. 1st p. 277–292.

    Chapter  Google Scholar 

  32. Lange JF, Kaufmann R, Wijsmuller AR, Pierie JP, Ploeg RJ, Chen DC, Amid PK. An international consensus algorithm for management of chronic postoperative inguinal pain. Hernia. 2014;19:33–43.

    Article  PubMed  Google Scholar 

  33. Sen H, Sizlan A, Yanarateş O, Senol MG, Inangil G, Sücüllü I, Ozkan S, Dağli G. The effects of gabapentin on acute and chronic pain after inguinal herniorrhaphy. Eur J Anaesthesiol. 2009;26(9):772–6.

    Article  CAS  PubMed  Google Scholar 

  34. Bjurstrom MF, Nicol AL, Amid PK, Chen DC. Pain control following inguinal herniorrhaphy: current perspectives. J Pain Res. 2014;7:277–90.

    PubMed  PubMed Central  Google Scholar 

  35. Werner MU. Management of persistent postsurgical inguinal pain. Langenbeck's Arch Surg. 2014;399:559–69.

    Article  Google Scholar 

  36. Bischoff, et al. Lidocaine patch (5%) in treatment of persistent inguinal postherniorrhaphy pain: a randomized, double- blind, placebo-controlled, crossover trial. Anaesthesiology. 2013;119:1444–52.

    Article  CAS  Google Scholar 

  37. Derry S, Sven-Rice A, Cole P, Tan T, Moore RA. Topical capsaicin (high concentration) for chronic neuropathic pain in adults. Cochrane Database Syst Rev. 2013;(2):CD007393.

    Google Scholar 

  38. Bischoff J, Koscielnaiak-Nielsen Z, Kehlet H, Werner M. Ultrasound-guided Ilioinguinal / Iliohypogastric nerve blocks for persistent inguinal Postherniorrhaphy pain: a randomized, double-blind, placebo-controlled, crossover trial. Pain Med. 2012;6:1323–9.

    Google Scholar 

  39. Parris D, Fischbein N, Mackey S, Carroll I. A novel CT-guided transpsoas approach to diagnostic genitofemoral nerve block and ablation. Pain Med. 2010;11:785–9.

    Article  PubMed  Google Scholar 

  40. Fanelli RD, DiSiena MR, Lui FY, Gersink KS. Cryoanalgesic ablation for the treatment of chronic postherniorraphy neuropathic pain. Surg Endosc. 2003;17:196–200.

    Article  CAS  PubMed  Google Scholar 

  41. Werner MU, Bischoff JM, Rathmell JP, Kehlet H. Pulsed radiofrequency in the treatment of persistent pain after inguinal herniotomy: a systematic review. Reg Anesth Pain Med. 2012;37(3):340–3.

    Article  PubMed  Google Scholar 

  42. Rauchwerger JJ, Giordano J, Rozen D, Kent JL, Greenspan J, Closson CW. On the therapeutic viability of peripheral nerve stimulation for ilioinguinal neuralgia: putative mechanisms and possible utility. Pain Pract. 2008;8:138–43.

    Article  PubMed  Google Scholar 

  43. Yakovlev AE, Al Tamimi M, Barolat G, et al. Spinal cord stimulation as alternative treatment for chronic post-herniorraphy pain. Neuromodulation. 2010;13:288–90; discussion 291

    Article  PubMed  Google Scholar 

  44. Schu S, Gulve A, ElDabe S, Baranidharan G, Wolf K, Demmel W, Rasche D, Sharma M, Klase D, Jahnichen G, Wahlstedt A, Nijhuis H, Liem L. Spinal cord stimulation (SCS) of the dorsal root ganglion (DRG) for groin pain – a retrospective review. Pain Pract. 2014;15:293–9.

    Article  PubMed  Google Scholar 

  45. Madura JA, Madura JA 2nd, Copper CM, Worth RM. Inguinal neurectomy for inguinal nerve entrapment: an experience with 100 patients. Am J Surg. 2005;189(3):283–7.

    Article  PubMed  Google Scholar 

  46. Zacest AC, Magill ST, Anderson VC, Burchiel KJ. Long-term outcome following ilioinguinal neurectomy for chronic pain. J Neurosurg. 2010;112(4):784–9.

    Article  PubMed  Google Scholar 

  47. Loos MJ, Scheltinga MR, Roumen RM. Tailored neurectomy for treatment of postherniorraphy inguinal neuralgia. Surgery. 2010;147(2):275–81.

    Article  PubMed  Google Scholar 

  48. 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(1):100–4.

    Article  PubMed  Google Scholar 

  49. Amid PK, Chen DC. Surgical treatment of chronic groin and testicular pain after laparoscopic and open preperitoneal inguinal hernia repair. J Am Coll Surg. 2011;213(4):531–6.

    Article  PubMed  Google Scholar 

  50. Campanelli G, Bertocchi V, Cavalli M, Bombini G, Biondi A, Tentorio T, Sfeclan C, Canziani M. Surgical treatment of chronic pain after inguinal hernia repair. Hernia. 2013;17:347–53.

    Article  CAS  PubMed  Google Scholar 

  51. Giger U, Wente MN, Büchler MW, Krähenbühl S, Lerut J, Krähenbühl L. Endoscopic retroperitoneal neurectomy for chronic pain after groin surgery. Br J Surg. 2009;96(9):1076–108.

    Article  CAS  PubMed  Google Scholar 

  52. Chen DC, Hiatt JR, Amid PK. Operative management of refractory neuropathic inguinodynia by a laparoscopic retroperitoneal approach. JAMA Surg. 2013;148:962–7.

    Article  PubMed  Google Scholar 

  53. HerniaSurge: International guidelines for the treatment of groin hernia. http://herniasurge.com/.

  54. Heise CP, Starling JR. Mesh inguinodynia: a new clinical syndrome after inguinal herniorrhaphy? J Am Coll Surg. 1998;187:514–8.

    Article  CAS  PubMed  Google Scholar 

  55. Bischoff JM, Enghuus C, Werner MU, Kehlet H. Long-term follow-up after mesh removal and selective neurectomy for persistent inguinal postherniorrhaphy pain. Hernia. 2013;17:339–45.

    Article  CAS  PubMed  Google Scholar 

  56. Nienhuijs S, Staal E, Bleichrodt R. Chronic pain after mesh repair of inguinal hernia: a systematic review. Am J Surg. 2007;194:394–400.

    Article  PubMed  Google Scholar 

  57. Aasvang EK, Gmaehle E, Hansen JB, Gmaehle B, Forman JL, Schwarz J, Bittner R, Kehlet H. Predictive risk factors for persistent postherniotomy pain. Anesthesiology. 2010;112(4):957–69. https://doi.org/10.1097/ALN.0b013e3181d31ff8.

    Article  PubMed  Google Scholar 

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Reinpold, W., Chen, D. (2018). Chronic Postoperative Inguinal Pain (CPIP). In: Bittner, R., Köckerling, F., Fitzgibbons, Jr., R., LeBlanc, K., Mittal, S., Chowbey, P. (eds) Laparo-endoscopic Hernia Surgery. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-55493-7_17

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