Reply To: Tissue repair experiences – pain and recovery

Hernia Discussion Forums Hernia Discussion Tissue repair experiences – pain and recovery Reply To: Tissue repair experiences – pain and recovery


Sure. Here’s a link. You need to log in, but it’s free. It’s a very interesting discussion – worth reading.

Surgery Roundtable

“Dr. Bendavid: I have done thousands of repairs when I have divided the nerve. I have always maintained that if there’s no nerve, there is no pain. And I’ve been somewhat cavalier also in dividing nerves for that matter. It seems that the sensory loss is minimal, and certainly considering that we have cut the nerves on nearly 7000 cases a year, we have not seen the kind of situation that Dr Amid is talking about. However, there seems to be a clear picture that Starling refers to as inguinodynia in Surgical Clinics of North America, where the contact of a severed nerve end with Marlex results in a pain syndrome.[51]

I’ve seen many patients with pain, but very few actually go on to the chronic type, which we should define as pain beyond a year; only 1% of these patients go on to have chronic pain. I don’t understand the problem, and I don’t think we have the answer. Perhaps, somehow, a twig or branches of the nerves are included in a suture line. I don’t know. It’s a very difficult problem to which I don’t have an answer. But certainly in the past, generally speaking, no nerve, no pain.”

“Dr. Bendavid: Well, I certainly have, over the years, severed many an ilioinguinal and an iliohypogastric, and don’t forget that when you do herniorrhaphies for recurrences from an anterior approach, you may not even see them, so that they are very often severed, and certainly if they are in the way, I have never hesitated to remove them, to resect them, and simply leave the stump behind without any ligation and have literally never seen any problems associated with this. And as I’ve said, the sensory loss is so minimal it seldom is larger than a 2 cm to 3 cm circle at the very medial portion of the inguinal area.”

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