Is the mesh itself the problem or is it handling of the nerves?

[Good intentions]

A recent paper attempting to understand where the pain comes from. Fixing problems “on the fly”. Hernia Journal apparently has one of those “How I Do It” sections. Showing that there is much randomness in the hernia repair field. I do it this way, I do it a different way, etc.

It’s another abstract so I don’t know if they have real data supporting their advice or if it’s a “gut feeling” type of paper. No pun intended. The word “likely” in the Introduction is a sign that they don’t have any data. If they don’t have data supporting their advice then the advice is of little value. More confusion. Why would Hernia even publish it?

https://link.springer.com/article/10.1007/s10029-023-02809-9

HOW-I-DO-IT
Published: 07 August 2023
Ten steps for proper peripheral nerve handling during inguinal hernia surgery
A. De la Fuente Hagopian, S. Farhat, S. Guadarrama-Sistos Vazquez, N. K. Reddy, J. Bombardelli & A. Echo
Hernia (2023)

“Abstract
Introduction
Post-inguinal pain after a hernia surgery is prevalent and can be quite frustrating for the surgeon and patient alike. There are several sources for possible post-operative inguinal pain after a successful hernia repair; however, in the setting where a recurrent inguinal hernia is not present, it is likely related to the nerves in the inguinal canal or pelvis. Chronic inguinal groin pain after hernia repairs have been reported in a high percentage of patients following inguinal hernia surgery despite being one of the most common procedures performed annually in the USA and worldwide.”

…

Conclusions
Understanding the proper handling of the inguinal nerves during hernia surgery can decrease the incidence of post-operative chronic pain by employing microsurgical concepts to day-to-day surgical procedures and prevent complications in an extensive set of patients.”

[David M]

This raises a question in my mind of whether anyone is actually keeping track of the explants.

I mean do any of the registries actually keep track of whether an explant was lap, lictenstein or plug and patch. That should indicate a lot. I know some of this must be known, because it’s obvious to Dr Towfigh that plug and patch has been a negative.

Information about nerves vs inflammation etc. would be a little more dubious, but still helpful.

[David M]

This is interesting. It doesn’t tell you how they developed the cohort of patients getting removal. There were quite a few more lap/robotic removals than open, but I dont see an indication of why that was.

It does indicate, seemingly, that open removal has less complications than lap/robotic.

https://www.ormanagement.net/Clinical-News/Article/03-22/Mesh-Removal-How-Much-Does-Surgical-Approach-Matter-/66120

[Author]

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