Reply To: The best strategy for the management of inguinodynia is prevention
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MarkT, thanks, you helped satisfy our curiosity. Let me note a couple of observations: I found inguinodynia defined as that related to mesh surgery. Not a crucial aspect but you do wish for preciseness of terms. The article combines both mesh and tissue repair, which if continued will require a redefining of terms. Not mentioned in the post above is the proportion of cases for each type of repair. Could be important.
Stranger still is nearly 2,000 patients observed but have a very very narrow range of age. Not only that but they are “all older vets, around 60yrs old.” These people have or had a physically vigorous occupation–the military. I believe in the general population a much, much wider range of age of patients would be the case. Or would it?
What might be happening is that many individuals 35-45 are coming with symptoms but he massages them into watchful waiting, at least some. It’s probably good in that he’s not pushing surgery on them. Finally, he might not include these patients in his case load figure until they actually get surgery.
That the article is a letter to the editor explains why data is not included. The doc is probably concurrently preparing a full article for publication somewhere.
Overall I think the biggest factor of his success is that he is likely a highly skilled surgeon based on his emphasis of correctly fitting mesh by size/shape for each patient and his neurectomy. This seems borne out by his using the same mesh since 2005. Was he just lucky in choosing mesh or has surgeon skill been much much more a factor than kind of mesh all along?
If we stick to GI’s original question, “what[‘s] the best prevention for post-hernia-repair pain” rather than treatment, then we must be confined to interventions before and up to completion of surgery. Thus treatment is excluded, which puts more emphasis on surgeon skill and patient physical condition.