The effect of mesh removal and selective neurectomy on persistent postherniotomy pain.
SUMMARY BACKGROUND DATA AND OBJECTIVE: Persistent pain affects everyday activities in 5% to 8% of patients after groin hernia repair. Because previous reports on the effect of neurectomy and/or mesh removal suffer from methodological problems we performed a detailed prospective trial of the effect of neurectomy and mesh removal on persistent postherniotomy pain.


METHODS
Twenty-one patients with postherniotomy pain >1 year, pain-related impairment of daily activities and a well-defined maximum pain localization where included. Inserted mesh was removed and a selective neurectomy was done in case of macroscopic nerve injury. The primary end point was changes in pain-related impairment of everyday activities assessed by the validated activities assessment scale before surgery and 6 months postoperatively. Quantitative sensory testing was used to evaluate sensory functions pre and postoperatively.


RESULTS
All patients completed the 6-month follow-up. There was a significant improvement in the activities assessment scale score for the whole group (preoperative vs. 6 months = 27 vs. 13 points, P = 0.004), despite 3 patients worsening. Quantitative sensory testing showed a significant postoperative increase in pressure pain detection threshold (P = 0.045) and cutaneous detection and pain thresholds (mechanical and warmth) (P < 0.03).


CONCLUSIONS
Selective neurectomy and mesh removal may improve pain-related activity impairment in patients with persistent postherniotomy pain. Detailed neurophysiologic assessment is recommended to identify patients who may or may not benefit from reoperation and to allocate patients to specific surgical and/or medical intervention.
Aasvang
Eske K
EK
Copenhagen University, Denmark. eskeaasvang@yahoo.dk
Kehlet
Henrik
H
D000328:Adult; D000368:Aged; D020878:Device Removal; D005260:Female; D006552:Hernia, Inguinal / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000209:etiology / Q000601:surgery*; D059348:Peripheral Nerve Injuries; D010525:Peripheral Nerves / Q000601:surgery; D011446:Prospective Studies; D013526:Surgical Mesh / Q000009:adverse effects*; D020196:Trauma, Nervous System / Q000209:etiology / Q000601:surgery