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Chronic neuropathic pain following inguinal hernia repair – Toufik Berri, 2017
Here is a recent review paper that seems very thorough. The author is at Department of Surgery, Tahri Mohammed University, Bechar, Algeria, and reports no conflicts and no funding. It seems objective. Submitted in 2017, not published online until 2019.
Here is the abstract:
“Since recurrence rates have been considerably reduced with mesh repairs, chronic pain has recently become the main concern after inguinal hernia repair (IHR), with significant impact on patient satisfaction, societal cost, and quality of life. Some 31% of all patients with persistent postsurgical pain develop neuropathic pain (NP) after IHR seeing that the inguinal nerves that cross the surgical field can directly or indirectly be damaged. Because of the multiplicity of the risk factors and the complexity of the pathophysiological mechanisms, substantial attention has been devoted to the multidisciplinary approaches and to the preventive measures. More clinical trials are needed to improve the level of evidence of the use of pharmacological, surgical, and interventional procedures in both prevention and treatment of chronic NP following IHR. In this article, the current objectives are to review the incidence, risk factors, pathogenesis, diagnosis, prevention, and treatment of chronic NP after IHR.”
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3 Replies
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[USER=”2029″]Good intentions[/USER]
Taking care of patients with chronic pain after mesh hernia repair is difficult because of the multiple factors involved.
It is the source of most of my gray hair (my wife caused the rest).
I wish more surgeons would return to the classic pure tissue repairs and avoid the chronic pain from the mesh.
Regards.
Bill Brown MD -
And the conclusion:
” Conclusion
Although tension-free procedures are considered as the gold standard of hernia repair, persistent postoperative pain continues to be reported after mesh implantations. Management of patients with chronic NP is a common and challenging problem after IHR. The complexity of mechanisms, wide variety of causes, and heterogeneity in clinical presentation require meticulous assessment and special investigations to recognize the NP, and multidisciplinary approach to produce effective treatment. More clinical trials are needed to identify patients who are at high risk and to develop preventive treatment strategies of chronic NP following hernia surgery.”
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The abstract is a bit misleading if not read carefully. He reports that 31% of patients who have “persistent postsurgical pain” develop neuropathic pain. Not that 31% of all patients develop pain. To be clear. He does not attempt to compile or estimate the actual chronic pain rate.
” Incidence
The reported incidence of chronic pain following IHR varies widely because of the nonstandardization of follow-up period, the diversity of pain-assessment methods and pain descriptors, and multiplicity of surgical procedures (open vs. laparoscopic repair and mesh vs. nonmesh repair). In a relatively recent systematic literature review, the prevalence of NP was 31% among patients with persistent postsurgical pain after IHR”
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