Reply To: New Book about Foregut Surgery with Inguinal Hernia Chapter
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Assuming a state-of-the-art book, it would be worthwhile to evaluate the book’s overall assessment of hernia complications as follows:
“Chronic or severe pain following inguinal herniorrhaphy is reported in 10% to 14% of the
cases. It remains a perplexing and challenging problem. it is associated with preoperative
chronic pain and with recurrent inguinal hernia repair. The identification and protection
of the ilioinguinal, genitofemoral, and iliohypogastric nerves are important in preventing
nerve entrapment injuries. if a nerve is injured, it should be transected and ligated
proximally, allowing it to retract into the muscle or preperitoneal space. Operative
treatment with planned resection of the three nerves can improve or resolve the pain.
However, a multidisciplinary pain team approach is imperative for optimal patient
outcomes.” (Itani & Sbayi, 2023)
At least one of the two authors advocates “mesh-free” surgery (though he also does mesh perhaps even more). Both are distinguished professors of surgery. They recognize chronic pain can be a post-op complication and point out an association with preoperative pain. Surgical technique is implied as a factor also. The field has yet apparently been unable to sort this out. If acknowledgement of chronic pain is only recent, then hardly much will be known about causation. Perhaps why this book chapter avoids relative results between mesh and non-mesh methods despite an author of the two being a non-mesh advocate (but not totally).
- This reply was modified 4 weeks, 1 day ago by pinto.