Reply To: American College of Surgeons (ACS) – Very strange “Bulletin”

Hernia Discussion Forums Hernia Discussion American College of Surgeons (ACS) – Very strange “Bulletin” Reply To: American College of Surgeons (ACS) – Very strange “Bulletin”

Good intentions

Here is a new article with Dr. Poulose as co-author. I have to assume that the other authors are the ones recognizing chronic pain as a major issue.

There seems to be some slight avoidance of an obvious conclusion – if nerve management during surgery is not a cause of pain, then what else could it be? Could it be caused by the mesh itself?

Are Nerves Left In Situ Associated With Less Chronic Pain Than Manipulation During Inguinal Hernia Repair?
Emily George MD, Molly A. Olson MS, Benjamin K. Poulose MD, MPH, FACS

Although guidelines emphasize three nerve preservation, the management strategies evaluated were not associated with statistically significant differences in pain 6 mo after operation. These findings suggest that nerve manipulation may not contribute as a significant role in chronic groin pain after open inguinal hernia repair.

Chronic pain is defined as pain that persists for more than 3 to 6 mo past the appropriate healing time for an injury.1 Pain can be neuropathic, which is defined as nerve damage, either via entrapment or dissection, or nociceptive, which is a peripheral sensory stimulation from localized inflammation.2 The rates of chronic pain after inguinal repair can be as high as 18%-51%.2, 3, 4 Given that more than one million inguinal hernia repairs are done in the United States every year, this rate of postoperative chronic pain leaves much opportunity for improvement.5

Emily George, MD: Nothing to disclose.

Molly A Olson, MS: The ACHQC has contracted with Weill Cornell Medicine to provide biostatistical support for ACHQC projects. The work provided for this manuscript was performed under the umbrella of the Weill Cornell Medicine and ACHQC collaboration plan.

Benjamin K Poulose, MD, MPH, FACS: Receives salary support from Abdominal Core Health Quality Collaborative (ACHQC). Receives research grant funds from BD Interventional and Advanced Medical Solutions.”

New Report


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