title: Long-term follow-up after meshectomy with acellular human dermis repair for postherniorrhaphy inguinodynia.
abstract: OBJECTIVE
  Direct inguinal hernia repair with acellular human dermis (AHD) may offer greater symptom improvement and lower risk of hernia recurrence than anatomical repair without mesh (AWM) after mesh removal (with or without neurectomy) for postherniorrhaphy inguinodynia.
  
  
  METHODS
  Retrospective cohort study with long-term follow-up.
  
  
  METHODS
  Tertiary referral center for mesh inguinodynia.
  
  
  METHODS
  Patients undergoing meshectomy (with or without neurectomy) for postherniorrhaphy inguinodynia were identified. Medical records were reviewed, and patients were contacted to evaluate outcomes. Patients whose postmeshectomy hernias were repaired using AHD vs AWM were compared.
  
  
  METHODS
  Patient satisfaction and recurrence.
  
  
  RESULTS
  Sixty-seven patients (35 in the AHD group and 32 in the AWM group) completed the follow-up. Patient demographics, duration and severity of symptoms, and time to meshectomy were similar between groups. The mean length of follow-up was 31.9 months for the AHD group and 80.2 months for the AWM group (P < .001). Fewer neurectomies were performed in the AHD group than in the AWM group (43% [15 of 35] vs 72% [23 of 32], P = .03). Eighty-three percent (29 of 35) of patients in the AHD group reported good or excellent groin pain improvement compared with 72% (23 of 32) of patients in the AWM group (P = .38). Eighty-three percent (29 of 35) of patients in the AHD group were satisfied with results compared with 81% (26 of 32) of patients in the AWM group (P = >.99). The AHD vs AWM procedures were associated with similar recovery, time to hernia recurrence, complication rates (11% [4 of 35] vs 3% [1 of 32], P = .36), and hernia recurrence rates (9% [3 of 35] vs 12% [4 of 32], P = .80). Predictors of patient dissatisfaction with meshectomy included patient smoking (odds ratio, 9.1; P = .01) and filing of workers' compensation claims (odds ratio, 12.8; P = .02).
  
  
  CONCLUSIONS
  Meshectomy (with or without neurectomy) for postherniorrhaphy inguinodynia leads to significant symptom improvement and patient satisfaction, with acceptable morbidity and recurrence rates. The use of AHD vs AWM does not improve iatrogenic hernia recurrence.
authors.affiliation: Division of General Surgery, Department of Surgery, University of Wisconsin-Madison, 600 Highland Ave, Madison, WI 53792, USA.
authors.forename: Matthew C
authors.initials: MC
authors.lastname: Koopmann
authors.forename: Brett H
authors.initials: BH
authors.lastname: Yamane
authors.forename: James R
authors.initials: JR
authors.lastname: Starling
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D001672:Biocompatible Materials / Q000627:therapeutic use*; D020405:Dermis / Q000637:transplantation; D020878:Device Removal; D005260:Female; D005500:Follow-Up Studies; D006552:Hernia, Inguinal / Q000209:etiology / Q000517:prevention & control / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures; D010149:Postoperative Pain / Q000209:etiology / Q000601:surgery; D017060:Patient Satisfaction; D017699:Pelvic Pain / Q000209:etiology / Q000601:surgery; D012189:Retrospective Studies; D055502:Secondary Prevention; D012907:Smoking; D013526:Surgical Mesh / Q000009:adverse effects; D013514:Surgical Procedures, Operative / Q000009:adverse effects / Q000379:methods; D013997:Time Factors; D016896:Treatment Outcome; D014942:Workers' Compensation
chemical_list: D001672:Biocompatible Materials