DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20204211

Incidence and management of inguinodynia after inguinal plasty

Juan J. Granados-Romero, Jesus C. Ceballos-Villalva, Israel García-Olivo, Cruz Escobar Jonathan E., María J. Corona-Torres, Alba M. Mondragón-Cordero, Quintero Arías Lourdes A., Ayala García Henry, Vázquez González Juan C., Ericka H. Contreras-Flores

Abstract


Background: Hernia is defined as a defect of fascial and muscle-aponeurotic structures, allowing the protrusion of elements. The most frequent is inguinal region, prevailing in men 3:1 vs female. The most frequent complications are persistent chronic pain.

Methods: A descriptive, prospective and cross-sectional study was performed in postoperative inguinal plasty patients, using a laparoscopic approach and open approach, the presence or absence of inguinodynia was studied using the visual analogue pain scale (VAS) and the Semmes-Weinstein monofilament, in addition to a systematic investigation in the following PubMed, Medline, Clinical Key and Index Medicus databases, with articles from July 2019 to April 2020.

Results: Inguinodynia was present in laparoscopic surgery and open approach, 58 patients had inguinodynia at two weeks associated with the inflammatory response of the tissues and the presence of a foreign body (mesh), 77% of the patients with persistence of pain at 3 months reported mild pain (VAS 1-4), 21% moderate pain that did not limit their daily activities (VAS 5-8) and 2% of the patients reported severe pain which limited physical activity and effort   (VAS 9-10).

Conclusions: Inguinodynia has an impact on hospital costs and quality life, we consider it is essential to domain the anatomical variants of the region. We propose an extensive follow-up of this group of patients, to make a comparison of diagnostic methods, as well as conservative management vs. modern techniques for pain control.


Keywords


Hernia, Inguinal, Inguinodynia, Lichtenstein, Mesh, Neurectomy

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References


Seker G, Kulacoglu H, Öztuna D, Topgül K, Akyol C, Çakmak A, et al. Changes in the Frequencies of Abdominal Wall Hernias and the Preferences for Their Repair: A Multicenter National Study From Turkey. Int Surg. 2014;99(5):534-42.

Dabbas N, Adams K, Pearson K, Royle G. Frequency of abdominal wall hernias: is classical teaching out of date? J Roy Soc Medic Sho Rep. 2011;2(1):5.

Yang X, Liu J. Anatomy essentials for laparoscopic inguinal hernia repair. Ann Transl Med 2016; 4(19):372.

Scott NW, McCormack K, Graham P, Go PM, Ross SJ, Grant AM. Open mesh versus non-mesh for repair of femoral and inguinal hernia. Cochrane Database Syst Rev. 2002;CD002197.

Ruhl CE, Everhart JE. Risk factors for inguinal hernia among adults in the US population. Am J Epidemiol. 2007;165:1154-61.

Granados-Romero JJ, Valderrama-Treviño AI, Mendoza-Barrera GE, Ceballos.-Villalva JC, Estrada-Mata AG, Méndez-Celis CA, et al. Comparison of early complications using regular mesh versus Atramat Neoflex 25 mesh in inguinal, umbilical and postincisional hernias. Int J Res Med Sci. 2016;4:194-7.

Palermo M, Acquafresca P, Bruno M, Tarsitano F. Hernioplasty with and without mesh: analysis of the inmmediate complications in a randomized controlled clinical trial. Arq Bras Cir Dig. 2015; 28(3):157-60

Pulido A, Carrillo J, Jalife A, Zaldívar R, Hurtado M. Inguinodinia en postoperados de plastía inguinal con técnica de Lichtenstein con resección versus preservación del nervio ilioinguinal ipsilateral. Ciruj Gener. 2012;34(1):18-24.

Minossi J, Minoss V, Silva A. Manejo da dor inguinal crônica pós-hernioplastia (inguinodinia). J Brazili Colle Surge 2011;38(1):59-65.

Van Hanswijck de Jonge P, Lloyd A, Horsfall L, Tan R, O'Dwyer PJ. The measurement of chronic pain and health related quality of life following inguinal hernia repair: a review of the literature. Hern. 2008;12:561-69.

Bodian CA, Freedman G, Hossain S, Eisenkraft JB, Beilin Y. The visual analog scale for pain: clinical significance in postoperative patients. Anesthesiol. 2001;95:1356-61.

Nikkolo C, Murruste M, Vaasna T, Seepter H, Tikk T, Lepner U. Three-year results of randomised clinical trial comparing lightweight mesh with heavyweight mesh for inguinal hernioplasty. Hern 2012;16:555-9.

EU Hernia Trialists Collaboration. Repair of groin hernia with synthetic mesh: meta-analysis of randomized controlled trials. Ann Surg. 2002;235:322-32.

Asociación Mexicana de Cirugía General. GPC Tratamiento de la hernia inguinal en el adulto. México. 2014.

Lange J, Meyer V, Voropai D, Keus E, Wijsmuller A, Ploeg R, et al. The rol of surgical expertise with regard to chronic postoperative inguinal pain (CPIP) after Lichtenstein correction of inguinal hernia: a systematic review. Hern. 2016;20(3):349-56.

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

Poobalan AS, Bruce J, King PM, Chambers WA, Krukowski ZH, Smith WCS. Chronic pain and quality of life following open inguinal hernia repair. Br J Surg. 2001; 88:1122-6.

Courtney CA, Duffy K, Serpell MG, O'Dwyer PJ. Outcome of patients with severe chronic pain following repair of groin hernia. Br J Surg. 2002;89:1310-4.

Zhong C, Wu B, Yang Z, Deng X, Kang J, Guo B, et al. A meta-analysis comparing lightweight meshes with heavyweight meshes in Lichtenstein inguinal hernia repair. Surg Innov. 2013;20(1): 24-31.

Reinpold W, Chen D. Die evidenzbasierte Lichtenstein-technik. Der Chirurg 2017; 88(4): 296-302.

Hernia Surge Group. International guidelines for groin hernia management. Hern. 2018;22(1):1-165.

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;19:188-99.

Nienhuijs S, Staal E, Stobbe L, Rosman C, Groenewoud H, Bleichrodt R. Chronic pain after mesh repair of inguinal hernia: a systematic review. Am J Surg. 2007;194:394-400.

Klinge U, Klosterhalfen B, Müller M, Schumpelick V. Foreign body reaction to meshes used for repair of abdominal wall hernias. Eur J Surg. 1999;165:665-73.

Hakeem A, Shanmugam V. Inguinodynia following Lichtenstein tension-free hernia repair: A review. World J Gastroenterol. 2011;17(14):1791-96.

Loos MJ, Roumen RM, Scheltinga MR. Classifying postherniorrhaphy pain syndromes following elective inguinal hernia repair. World J Surg. 2007;31:1760-5.

Aasvang EK, Møhl B, Kehlet H. Ejaculatory pain: a specific postherniotomy pain syndrome? Anesthesiol. 2007;107:298-304.

Bittmer R, Leibl B, Kraft B, Schwarz J. One-year results of a prospective, randomised clinical trial comparing four meshes in laparoscopic inguinal hernia repair (TAPP). Hern. 2011;15:503-10.

O’Dwyer PJ, Kingsnorth AN, Molloy RG, Small PK, Lammers B, Horeyseck G. Randomized clinical trial assessing impact of a lightweight mesh or heavyweight mesh on chronic pain after inguinal hernia repair. Br J Surg. 2005;92:166-70.

Post S, Weiss B, Willer M, Neufang T, Lorenz D. Randomized clinical trial of lightweight composite mesh for Lichtenstein inguinal hernia repair. Br J Surg. 2004;91:44-8.

Brown CN, Finch JG. Which mesh for hernia repair? Ann R Coll Surg Engl. 2010;92:272-8.

Simsons MP, Aufenacker T, Bay-Nielsen M, Bouillot JL, Campanelli G, Conze J, et al. European hernia society guidelines on the treatment of inguinal hernia in adult patients. Hernia 2009;13: 343-403.

Bringman S, Wollert S, Österberg J, Smedberg S, Granlund H, Heikkinen TJ. Three-year results of a randomized clinical trial of lightweight or standard polypropylene mesh in Lichtenstein repair of primary inguinal hernia. Br J Surg. 2006;93:1056-59.

Heikkinen TJ, Wollert S, Österberg J, Smedberg S, Bringman S. Early results of a randomised trial comparing Prolene and Vyproll-mesh in endoscopic extraperitoneal inguinal hernia repair (TEP) of recurrent unilateral hernias. Hern. 2006;10:34-40.

Langenbach MR, Schmidt J, Zirngibl H. Comparison of biomaterials: three meshes and TAPP for inguinal hernia. Surg Endosc. 2006;20:1511-7.

Agarval BB, Agarval KA, Mahajan KC. Prospective double-blind randomized controlled study comparing heavy- and lightweight polypropylene mesh in totally extraperitoneal repair of inguinal hernia: early results. Surg Endosc. 2009;23:242-7.

Chowbey PK, Garg N, Sharma A, Khullar R, Soni V, Baijal M, et al. Prospective, randomized, clinical trial comparing lightweight mesh and heavyweight polypropylene mesh in endoscopic totally extraperitoneal groin hernia repair. Surg Endosc. 2010;24:3073-9.

Taylor C, Layani L, Liew V, Ghusn M, Crampton N, White S. Laparoscopic inguinal hernia repair without mesh fixation, early results of a large randomised clinical trial. Surg Endosc. 2008;22: 757-62.

Nikkolo C, Lepner U. Chronic pain after open inguinal hernia repair. Postgrad Med. 2016;128(1): 69-75.

Zieren J, Rosenberg T, Menenakos Ch. Impact of ilioinguinal nerve excision on sexual function in open inguinal hernia mesh repair: a prospective follow-up study. Acta Chir Belg. 2008;108:409-13.