Skip to main content
Erschienen in: Hernia 4/2015

01.08.2015 | Original Article

Long-term outcome of surgical treatment of chronic postoperative groin pain: a word of caution

verfasst von: E. Valvekens, Y. Nijs, M. Miserez

Erschienen in: Hernia | Ausgabe 4/2015

Einloggen, um Zugang zu erhalten

Abstract

Purpose

Chronic postoperative groin pain is widely accepted to be a serious clinical condition after inguinal hernia repair and Pfannenstiel incision. Surgical treatment has been reported to be effective, but the long-term outcome following these interventions remains unclear. This retrospective study reports the outcome and investigates patient and intra-operative factors to identify possible predictors of success. A literature review of other outcome studies with more than 1 year follow-up is also presented.

Methods

A registry of patients who underwent surgery for chronic postoperative groin pain was analyzed. Pain was assessed using DN4-score and VAS-scale. Primary endpoint was successful pain reduction, as defined by the ratio of VASmax (post/pre) and the subjective outcome (better vs. same-worse).

Results

Fifteen patients underwent surgery for chronic postoperative groin pain between December 2000 and April 2010. Overall, significant pain reduction was achieved in 1/3 of patients. There was no significant association between patient or intra-operative factors and favorable outcome. A complete concordance between subjective outcome and the ratio of VASmax (post/pre) was noted.

Conclusion

The success of surgery for chronic postoperative groin pain is difficult to predict. In this study, one in three patients benefits from an operative treatment. The ratio of VASmax (post/pre) is suggested as a useful pain assessment tool. A further prospective study of sufficient sample size is necessary to identify possible factors associated with favorable outcome after surgery for chronic groin pain.
Literatur
1.
Zurück zum Zitat Primatesta P, Goldacre MJ (1996) Inguinal hernia repair: incidence of elective and emergency surgery, readmission and mortality. Int J Epidemiol 25(4):835–839PubMedCrossRef Primatesta P, Goldacre MJ (1996) Inguinal hernia repair: incidence of elective and emergency surgery, readmission and mortality. Int J Epidemiol 25(4):835–839PubMedCrossRef
2.
Zurück zum Zitat Massaron S, Bona S, Fumagalli U, Valente P, Rosati R (2008) Long-term sequelae after 1,311 primary inguinal hernia repairs. Hernia 12:57–63PubMedCrossRef Massaron S, Bona S, Fumagalli U, Valente P, Rosati R (2008) Long-term sequelae after 1,311 primary inguinal hernia repairs. Hernia 12:57–63PubMedCrossRef
3.
Zurück zum Zitat Poobalan AS, Bruce J, Cairns W, Smith S, King PM, Krukowski ZH, Chambers WA (2003) A review of chronic pain after inguinal herniorrhaphy. Clin J Pain 19:48–54PubMedCrossRef Poobalan AS, Bruce J, Cairns W, Smith S, King PM, Krukowski ZH, Chambers WA (2003) A review of chronic pain after inguinal herniorrhaphy. Clin J Pain 19:48–54PubMedCrossRef
4.
Zurück zum Zitat Bay-Nielsen M, Perkins FM, Kehlet H (2001) Pain and functional impairment 1 year after inguinal herniorrhaphy: a nationwide questionnaire study. Ann Surg 233:1–7PubMedCentralPubMedCrossRef Bay-Nielsen M, Perkins FM, Kehlet H (2001) Pain and functional impairment 1 year after inguinal herniorrhaphy: a nationwide questionnaire study. Ann Surg 233:1–7PubMedCentralPubMedCrossRef
5.
Zurück zum Zitat Nienhuijs S, Staal E, Strobbe L, Rosman C, Groenewoud H, Bleichrodt R (2007) Chronic pain after mesh repair of inguinal hernia: a systematic review. Am J Surg 194:394–400PubMedCrossRef Nienhuijs S, Staal E, Strobbe L, Rosman C, Groenewoud H, Bleichrodt R (2007) Chronic pain after mesh repair of inguinal hernia: a systematic review. Am J Surg 194:394–400PubMedCrossRef
6.
Zurück zum Zitat Loos MJA, Roumen RMH, Scheltinga MRM (2007) Chronic sequelae of common elective groin hernia repair. Hernia 11:169–173PubMedCrossRef Loos MJA, Roumen RMH, Scheltinga MRM (2007) Chronic sequelae of common elective groin hernia repair. Hernia 11:169–173PubMedCrossRef
7.
Zurück zum Zitat Alfieri S, Amid PK, Campanelli G, Izard G, Kehlet H, Wijsmuller AR, Di Miceli D, Doglietto GB (2011) International guidelines for prevention and management of post-operative chronic pain following inguinal hernia surgery. Hernia 15(3):239–249PubMedCrossRef Alfieri S, Amid PK, Campanelli G, Izard G, Kehlet H, Wijsmuller AR, Di Miceli D, Doglietto GB (2011) International guidelines for prevention and management of post-operative chronic pain following inguinal hernia surgery. Hernia 15(3):239–249PubMedCrossRef
8.
Zurück zum Zitat Aasvang E, Kehlet H (2005) Chronic postoperative pain: the case of inguinal herniorrhaphy. Br J Anaesth 95:69–76PubMedCrossRef Aasvang E, Kehlet H (2005) Chronic postoperative pain: the case of inguinal herniorrhaphy. Br J Anaesth 95:69–76PubMedCrossRef
9.
Zurück zum Zitat Aasvang E, Kehlet H (2005) Surgical management of chronic pain after inguinal hernia repair. Br J Surg 92:795–801PubMedCrossRef Aasvang E, Kehlet H (2005) Surgical management of chronic pain after inguinal hernia repair. Br J Surg 92:795–801PubMedCrossRef
10.
Zurück zum Zitat Delikoukos S, Fafoulakis F, Christodoulidis G, Theodoropoulos T, Hatzitheofilou C (2008) Re-operation due to severe late-onset persisting groin pain following anterior inguinal hernia repair with mesh. Hernia 12:593–595PubMedCrossRef Delikoukos S, Fafoulakis F, Christodoulidis G, Theodoropoulos T, Hatzitheofilou C (2008) Re-operation due to severe late-onset persisting groin pain following anterior inguinal hernia repair with mesh. Hernia 12:593–595PubMedCrossRef
11.
Zurück zum Zitat Aasvang E, Kehlet H (2009) The effect of mesh removal and selective neurectomy on persistent postherniotomy pain. Ann Surg 249:327–334PubMedCrossRef Aasvang E, Kehlet H (2009) The effect of mesh removal and selective neurectomy on persistent postherniotomy pain. Ann Surg 249:327–334PubMedCrossRef
12.
Zurück zum Zitat Loos MJ, Scheltinga MR, Roumen RM (2010) Tailored neurectomy for treatment of post-herniorrhaphy inguinal neuralgia. Surgery 147(2):275–281PubMedCrossRef Loos MJ, Scheltinga MR, Roumen RM (2010) Tailored neurectomy for treatment of post-herniorrhaphy inguinal neuralgia. Surgery 147(2):275–281PubMedCrossRef
13.
Zurück zum Zitat Vuilleumier H, Hübner M, Demartines N (2009) Neuropathy after herniorrhaphy: indication for surgical treatment and outcome. World J Surg 33(4):841–845PubMedCrossRef Vuilleumier H, Hübner M, Demartines N (2009) Neuropathy after herniorrhaphy: indication for surgical treatment and outcome. World J Surg 33(4):841–845PubMedCrossRef
14.
Zurück zum Zitat Bouhassira D, Attal N, Alchaar H, Boureau F, Brochet B, Bruxelle J, Cunin G, Fermanian J, Ginies P, Grun-Overdyking A, Jafari-Schluep H, Lantéri-Minet M, Laurent B, Mick G, Serrie A, Valade D, Vicaut E (2005) Comparison of pain syndromes associated with nervous or somatic lesions and development of a new neuropathic pain diagnostic questionnaire (DN4). Pain 114:29–36PubMedCrossRef Bouhassira D, Attal N, Alchaar H, Boureau F, Brochet B, Bruxelle J, Cunin G, Fermanian J, Ginies P, Grun-Overdyking A, Jafari-Schluep H, Lantéri-Minet M, Laurent B, Mick G, Serrie A, Valade D, Vicaut E (2005) Comparison of pain syndromes associated with nervous or somatic lesions and development of a new neuropathic pain diagnostic questionnaire (DN4). Pain 114:29–36PubMedCrossRef
15.
16.
Zurück zum Zitat Amid PK (2004) Causes, prevention, and surgical treatment of postherniorrhaphy neuropathic inguinodynia: triple neurectomy with proximal end implantation. Hernia 8:343–349PubMedCrossRef Amid PK (2004) Causes, prevention, and surgical treatment of postherniorrhaphy neuropathic inguinodynia: triple neurectomy with proximal end implantation. Hernia 8:343–349PubMedCrossRef
17.
Zurück zum Zitat Keller JE, Stefandis D, Dolce CJ, Iannitti DA, Kercher KW, Heniford BT (2008) Combined open and laparoscopic approach to chronic groin pain after inguinal hernia repair. Am Surg 74(8):695–700PubMed Keller JE, Stefandis D, Dolce CJ, Iannitti DA, Kercher KW, Heniford BT (2008) Combined open and laparoscopic approach to chronic groin pain after inguinal hernia repair. Am Surg 74(8):695–700PubMed
18.
Zurück zum Zitat Rab M, Ebmer J, Dellon AL (2001) Anatomic variability of the ilioinguinal and genitofemoral nerve: implications for the treatment of groin pain. Plast Reconstr Surg 108(6):1618–1623PubMedCrossRef Rab M, Ebmer J, Dellon AL (2001) Anatomic variability of the ilioinguinal and genitofemoral nerve: implications for the treatment of groin pain. Plast Reconstr Surg 108(6):1618–1623PubMedCrossRef
19.
Zurück zum Zitat Giger U, Wente MN, Büchler MW, Krähenbühl S, Lerut J, Krähenbühl L (2009) Endoscopic retroperitoneal neurectomy for chronic pain after groin surgery. Br J Surg 96:1076–1081PubMedCrossRef Giger U, Wente MN, Büchler MW, Krähenbühl S, Lerut J, Krähenbühl L (2009) Endoscopic retroperitoneal neurectomy for chronic pain after groin surgery. Br J Surg 96:1076–1081PubMedCrossRef
20.
Zurück zum Zitat Amid PK (2002) A 1-stage surgical treatment for post-herniorrhaphy neuropathic pain: triple neurectomy and proximal end implantation without mobilization of the cord. Arch Surg 137(1):100–104PubMedCrossRef Amid PK (2002) A 1-stage surgical treatment for post-herniorrhaphy neuropathic pain: triple neurectomy and proximal end implantation without mobilization of the cord. Arch Surg 137(1):100–104PubMedCrossRef
22.
Zurück zum Zitat Loos MJA, Scheltinga MRM, Roumen RMH (2008) Surgical management of inguinal neuralgia after a low transverse Pfannenstiel incision. Ann Surg 248(5):880–885PubMedCrossRef Loos MJA, Scheltinga MRM, Roumen RMH (2008) Surgical management of inguinal neuralgia after a low transverse Pfannenstiel incision. Ann Surg 248(5):880–885PubMedCrossRef
23.
Zurück zum Zitat Bower S, Moore BB, Weiss SM (1996) Neuralgia after inguinal hernia repair. Am Surg 62(8):664–667PubMed Bower S, Moore BB, Weiss SM (1996) Neuralgia after inguinal hernia repair. Am Surg 62(8):664–667PubMed
24.
Zurück zum Zitat Ducic I, West J, Maxted W (2008) Management of chronic postoperative groin pain. Ann Plast Surg 60(3):294–298PubMedCrossRef Ducic I, West J, Maxted W (2008) Management of chronic postoperative groin pain. Ann Plast Surg 60(3):294–298PubMedCrossRef
25.
Zurück zum Zitat Zacest AC, Magill ST, Anderson VC, Burchiel KJ (2010) Long-term outcome following ilioinguinal neurectomy for chronic pain. J Neurosurg 112(4):784–789PubMedCrossRef Zacest AC, Magill ST, Anderson VC, Burchiel KJ (2010) Long-term outcome following ilioinguinal neurectomy for chronic pain. J Neurosurg 112(4):784–789PubMedCrossRef
26.
Zurück zum Zitat Heise CP, Starling JR (1998) Mesh inguinodynia: a new clinical syndrome after inguinal herniorrhaphy? J Am Coll Surg 187(5):514–518PubMedCrossRef Heise CP, Starling JR (1998) Mesh inguinodynia: a new clinical syndrome after inguinal herniorrhaphy? J Am Coll Surg 187(5):514–518PubMedCrossRef
27.
Zurück zum Zitat Bennett M (2001) The LANSS pain scale: the Leeds assessment of neuropathic symptoms and signs. Pain 92:147–157PubMedCrossRef Bennett M (2001) The LANSS pain scale: the Leeds assessment of neuropathic symptoms and signs. Pain 92:147–157PubMedCrossRef
28.
Zurück zum Zitat Eklund A, Montgomery A, Bergkvist L, Rudberg C (2010) Chronic pain 5 years after randomized comparison of laparoscopic and Lichtenstein inguinal hernia repair. Br J Surg 97:600–608PubMedCrossRef Eklund A, Montgomery A, Bergkvist L, Rudberg C (2010) Chronic pain 5 years after randomized comparison of laparoscopic and Lichtenstein inguinal hernia repair. Br J Surg 97:600–608PubMedCrossRef
Metadaten
Titel
Long-term outcome of surgical treatment of chronic postoperative groin pain: a word of caution
verfasst von
E. Valvekens
Y. Nijs
M. Miserez
Publikationsdatum
01.08.2015
Verlag
Springer Paris
Erschienen in
Hernia / Ausgabe 4/2015
Print ISSN: 1265-4906
Elektronische ISSN: 1248-9204
DOI
https://doi.org/10.1007/s10029-013-1125-4

Weitere Artikel der Ausgabe 4/2015

Hernia 4/2015 Zur Ausgabe

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

Karpaltunnelsyndrom BDC Leitlinien Webinare
CME: 2 Punkte

Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis
Berufsverband der Deutschen Chirurgie e.V.

S2e-Leitlinie „Distale Radiusfraktur“

Radiusfraktur BDC Leitlinien Webinare
CME: 2 Punkte

Das Webinar beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske
Dr. med. Benjamin Meyknecht
Berufsverband der Deutschen Chirurgie e.V.

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

Appendizitis BDC Leitlinien Webinare
CME: 2 Punkte

Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.