Neuropathy after herniorrhaphy: indication for surgical treatment and outcome.
BACKGROUND
Chronic neuropathy after hernia repair is a neglected problem as very few patients are referred for surgical treatment. The aim of the present study was to assess the outcome of standardized surgical revision for neuropathic pain after hernia repair.


METHODS
In a prospective cohort study we evaluated all patients admitted to our tertiary referral center for surgical treatment of persistent neuropathic pain after primary herniorrhaphy between 2001 and 2006. Diagnosis of neuropathic pain was based on clinical findings and a positive Tinel's sign. Postoperative pain was evaluated by a visual analogue scale (VAS) and a pain questionnaire up to 12 months after revision surgery.


RESULTS
Forty-three consecutive patients (39 male, median age 35 years) underwent surgical revision, mesh removal, and radical neurectomy. The median operative time was 58 min (range: 45-95 min). Histological examination revealed nerve entrapment, complete transection, or traumatic neuroma in all patients. The ilioinguinal nerve was affected in 35 patients (81%); the iliohypogastric nerve, in 10 patients (23%). Overall pain (median VAS) decreased permanently after surgery within a follow-up period of 12 months (preoperative 74 [range: 53-87] months versus 0 [range: 0-34] months; p<0.0001).


CONCLUSIONS
The results of this cohort study suggest that surgical mesh removal with ilioinguinal and iliohypogastric neurectomy is a successful treatment in patients with neuropathic pain after hernia repair.
Vuilleumier
Henri
H
Department of Visceral Surgery, Centre Hospitalier Universtaire Vaudois (CHUV), University Hospital, Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland. henri.vuilleumier@chuv.ch
Hübner
Martin
M
Demartines
Nicolas
N
D000293:Adolescent; D000328:Adult; D001938:Brazil; D002908:Chronic Disease; D005260:Female; D005267:Femoral Nerve / Q000033:anatomy & histology; D006552:Hernia, Inguinal / Q000601:surgery*; D006801:Humans; D007264:Inguinal Canal / Q000294:innervation; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods; D010147:Pain Measurement; D010149:Postoperative Pain / Q000601:surgery*; D011446:Prospective Studies; D012086:Reoperation; D013526:Surgical Mesh; D055815:Young Adult