title: Neurophysiological characterization of persistent pain after laparoscopic inguinal hernia repair.
abstract: OBJECTIVE
  About 2-5% of patients undergoing laparoscopic inguinal repair experience persistent pain influencing everyday activities. However, compared with persistent pain after open repair, the combined clinical and neurophysiological characteristics have not been described in detail. Thus, the aim of the study was to describe and classify patients with severe persistent pain after laparoscopic herniorrhaphy.
  
  
  METHODS
  Eleven patients with severe persistent pain following laparoscopic inguinal herniorrhaphy were assessed in detail by their medical history, questionnaires (impairments of daily activities, pain description, psychological parameters, socio-economic status), physical examination, sensory mapping, and quantitative sensory testing.
  
  
  RESULTS
  The median time since operation was 2 years (range 1-14 years). Ten patients experienced pain in the inguinal region and five patients had pain outside the inguinal region. Based upon the clinical pain pattern and the detailed quantitative sensory testing, the patients could be separated into three different entities, suggesting different pathogenic mechanisms leading to the persistent pain state. Four patients experienced dysejaculation. Six patients were unemployed or retired due to the postherniorrhaphy pain.
  
  
  CONCLUSIONS
  These results suggest that patients with severe persistent pain after laparoscopic inguinal herniorrhaphy belong to distinctive subgroups with indicators of either neuropathic, inflammatory, or mechanical irritation from the mesh, or a combination of these symptoms. The findings of a number of pain localizations outside the inguinal region demarcate it from persistent pain following open groin hernia repair. A classification based on a larger study group is required in order to define mechanism-based treatment strategies.
authors.affiliation: Section of Surgical Pathophysiology 4074, Rigshospitalet, Copenhagen University, Blegdamsvej 9, 2100 Copenhagen, Denmark.
authors.forename: G
authors.initials: G
authors.lastname: Linderoth
authors.forename: H
authors.initials: H
authors.lastname: Kehlet
authors.forename: E K
authors.initials: EK
authors.lastname: Aasvang
authors.forename: M U
authors.initials: MU
authors.lastname: Werner
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D059350:Chronic Pain / Q000145:classification* / Q000209:etiology / Q000503:physiopathology*; D003080:Cold Temperature; D004651:Employment; D006552:Hernia, Inguinal / Q000601:surgery*; D059685:Herniorrhaphy / Q000009:adverse effects*; D006358:Hot Temperature; D006801:Humans; D007249:Inflammation / Q000209:etiology / Q000503:physiopathology; D010535:Laparoscopy / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D009437:Neuralgia / Q000209:etiology / Q000503:physiopathology; D010147:Pain Measurement; D010149:Postoperative Pain / Q000145:classification* / Q000209:etiology / Q000503:physiopathology*; D011312:Pressure; D012735:Sexual Dysfunction, Physiological / Q000209:etiology; D020886:Somatosensory Disorders / Q000209:etiology / Q000503:physiopathology; D013526:Surgical Mesh / Q000009:adverse effects; D011795:Surveys and Questionnaires; D013997:Time Factors; D014110:Touch; D055815:Young Adult