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Why do inguinal hernia patients have pain? Histology points to compression …
I found an interesting new hypothesis for groin pain. It runs in the same vein as Dr. Bendavid’s work on the biochemical environment around nerves in mesh.
The authors resected the ilioinguinal nerve in patients that were undergoing Lichtenstein repair. They examined the nerves afterward. There does not seem to be any follow-up to evaluate post-surgery pain.
https://www.sciencedirect.com/science/article/abs/pii/S0002961016309722
Why do inguinal hernia patients have pain? Histology points to compression neuropathy
Robert Wright MD, Donald E. Born MD, PhD, Natasha D’Souza, Larissa Hurd, Rachel Gill, Daniel Wright“Purpose
The purpose of this study is to describe the known soft tissue neuro-histology factors associated with compression neuropathy in relation to the incidence of preoperative pain in primary inguinal hernia. Enlargement of the ilioinguinal nerve occurs in 63% of patients with primary inguinal hernia; compression neuropathy has similar gross features.… ”
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Here is a link to their practice website. The publications and the website imply that they do many Lichtenstein repairs.
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Here is an earlier paper that is open access, on the same general topic. It has some very good illustrations, showing how the nerves exit the abdominal wall at different places, and of the inguinal canal and spermatic cord.
The authors seems to be well-informed. It would be interesting to know what their repair choices are.
https://www.scirp.org/html/7-2100840_47865.htm
Inguinal Neuritis in Open Recurrent Hernia Repair
Robert Charles Wright, Robert James Wright
Cascade Hernia & Heartburn Institute, Meridian Surgical Center, Puyallup, USA“PURPOSE: To investigate the pattern of occurrence of inguinal neuritis in recurrent inguinal hernia. We hypothesize that neuritis will occur in more nerves with a wider distribution than in primary repair. METHODS: Retrospective chart review of thirty consecutive recurrent inguinal hernia repairs concentrating on the occurrence of inguinal neuritis. These are not chronic pain patients. Nerves suspected of containing inguinal neuritis were sent for histologic examination. Ilioinguinal nerves were routinely resected. Operative parameters and nerve pathology reports were reviewed. These data were compared with a recent series of one hundred consecutive primary inguinal hernia repairs with a 34% incidence of inguinal neuritis. An independent statistician from Whitman University reviewed the data. … ”
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