Original Scientific Articles
Mesh inguinodynia: a new clinical syndrome after inguinal herniorrhaphy?

https://doi.org/10.1016/S1072-7515(98)00215-4Get rights and content

Abstract

Background: Chronic inguinodynia or neuralgia after conventional inguinal herniorrhaphy is rare, and diagnosing the exact cause is difficult. Treatment has ranged from local injection to remedial surgery with variable results. The increasing popularity of prosthetic mesh repairs (tension free, plug, or laparoscopic) has not eliminated these pain syndromes from occasionally occurring. Recommended management in these situations is extremely difficult.

Study Design: Since 1994, 117 inguinal reexplorations have been performed for inguinodynia and 20 of these patients had primary mesh herniorrhaphy. All 20 patients had mesh removal. Records were reviewed and patients contacted to evaluate outcomes.

Results: All 20 patients were evaluated (15 by telephone or direct contact, 5 by chart review). Three patients had their initial repair performed laparoscopically. Symptoms persisted for 12.2 ± 1.7 months before remedial surgery. Four patients underwent inguinal reexploration and mesh removal; 16 had mesh removal plus ilioinguinal or iliohypogastric neurectomy. Good to excellent results were achieved in 12 out of 20 patients (60%). Average followup time was 15.9 ± 3.1 months. Two of 3 patients who had laparoscopic herniorrhaphy had favorable outcomes (67%). Ten of the 16 patients who had mesh removal plus neurectomy reported good to excellent results (62%) compared with 2 of 4 reporting the same with mesh excision only (50%). Eleven patients had pain relief with preoperative nerve block. Of these, 9 had elective neurectomy resulting in good to excellent results in 5 (56%).

Conclusions: Remedial inguinal exploration and mesh removal with or without neurectomy resulted in favorable outcomes in 60% of patients with mesh herniorrhaphy chronic inguinodynia (neuralgia). It appears that coincident neurectomy affords better results than mesh removal alone. Relief with nerve block did not predict favorable outcomes. Despite the popularity and favorable outcomes of prosthetic mesh repairs, persistent postoperative pain still occurs in a small cohort of patients. This may become more evident with the rising interest in laparoscopy. Correcting this problem once presented can be a formidable task. Remedial inguinal surgery with mesh removal and neurectomy will cure selected patients.

Section snippets

Methods

One hundred seventeen patients from the United States underwent remedial groin exploration for chronic inguinodynia after referral to the senior author between 1994 and 1997. Of these patients, 20 had previous mesh herniorrhaphy with chronic inguinodynia and had mesh removal. Only patients with previous mesh herniorrhaphy and chronic inguinodynia were reviewed. All patient records were reviewed, and 15 patients were contacted to evaluate outcomes at least 1 month after remedial surgery.

Results

Our study patients included 17 males and 3 females as shown in Table 1. The age range was from 20 to 71 years with an average of 42 ± 3.4 years. Twelve remedial explorations were right-sided and eight left-sided. All had previous mesh herniorrhaphy with 3 patients having their primary repair performed laparoscopically. In addition to inguinodynia, 13 patients reported pain into the scrotum or labia majora and 2 patients reported pain into the anterolateral thigh (meralgia paresthetica). Eight

Discussion

Inguinal neuralgia, neuropathy, or inguinodynia is now a well-described, albeit rare, complication of inguinal herniorrhaphy. Initial reports date back to the 1940s,1, 2 describing genitofemoral causalgia. Since then multiple reports have appeared in the literature. The incidence of persistent pain has been estimated at 1% to 2%.3 Hagen and coworkers13 reported that 10.6% of patients having open inguinal herniorrhaphy (especially McVay Cooper’s ligament repair) complained of moderate or severe

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