title: Chronic pain after TEP inguinal hernia repair, does MRI reveal a cause?
abstract: OBJECTIVE
  Persistent pain is a known side effect after TEP inguinal repair disabling 2-5% of patients. A standardized diagnostic work-up so far is not available. MRI is a diagnostic tool in the work-up of inguinal hernias. In the present study the yield of MRI in evaluating chronic pain after TEP hernia repair is addressed.
  
  
  METHODS
  In our database patients receiving an MRI scan for groin pain lasting more than 3 months after TEP inguinal hernia repair were identified. A checklist with potential pathologic findings was filled out for each groin by two blinded observers. Findings in painful, pain-free and unoperated groins were compared and statistical analysis done based upon their relative incidences. Cohen's kappa coefficients were calculated to determine interobserver agreement.
  
  
  RESULTS
  Imaging studies of 53 patients revealed information regarding 106 groins. Fifty-five groins were painful after the initial operation, 12 were pain-free postoperatively and 39 groins were not operated. None of the predefined disorders was observed statistically more often in the patients with painful groins. Only fibrosis appeared more prevalent in patients with chronic pain (P = 0.11). Interobserver agreement was excellent for identifying the mesh (κ = 0.88) and observing bulging or a hernia (κ = 0.74) and was substantial for detecting fibrosis (κ = 0.63). In 40% of the patients, MRI showed a correct mesh position and observed nothing else than minor fibrosis. A wait and see policy resolved complaints in the majority of the patients. In 15 % of the patients, MRI revealed treatable findings explanatory for persisting groin pain.
  
  
  CONCLUSIONS
  For patients with post-TEP hernia groin pain, MRI is useful to confirm a correct flat mesh position and to identify possible not operation-related causes of groin pain. It is of little help to identify a specific cause of groin repair-related pain.
authors.affiliation: Department of Surgery/Hernia Clinic, Diakonessenhuis Utrecht/Zeist, Room: Secretariaat Heelkunde, Professor Lorentzlaan 76, 3707 HL, Zeist, The Netherlands. iburgmans@diakhuis.nl.
authors.forename: J P J
authors.initials: JP
authors.lastname: Burgmans
authors.affiliation: Department of Surgery/Hernia Clinic, Diakonessenhuis Utrecht/Zeist, Room: Secretariaat Heelkunde, Professor Lorentzlaan 76, 3707 HL, Zeist, The Netherlands.
authors.forename: C E H
authors.initials: CE
authors.lastname: Voorbrood
authors.affiliation: Department of Surgery/Hernia Clinic, Diakonessenhuis Utrecht/Zeist, Room: Secretariaat Heelkunde, Professor Lorentzlaan 76, 3707 HL, Zeist, The Netherlands.
authors.forename: T
authors.initials: T
authors.lastname: Van Dalen
authors.affiliation: Department of Radiology/Hernia Clinic, Diakonessenhuis Utrecht/Zeist, Zeist, The Netherlands.
authors.forename: R N
authors.initials: RN
authors.lastname: Boxhoorn
authors.affiliation: Department of Surgery/Hernia Clinic, Diakonessenhuis Utrecht/Zeist, Room: Secretariaat Heelkunde, Professor Lorentzlaan 76, 3707 HL, Zeist, The Netherlands.
authors.forename: G J
authors.initials: GJ
authors.lastname: Clevers
authors.affiliation: Department of Radiology/Hernia Clinic, Diakonessenhuis Utrecht/Zeist, Zeist, The Netherlands.
authors.forename: F B M
authors.initials: FB
authors.lastname: Sanders
authors.affiliation: Department of Radiology/Hernia Clinic, Diakonessenhuis Utrecht/Zeist, Zeist, The Netherlands.
authors.forename: D B J
authors.initials: DB
authors.lastname: Naafs
authors.affiliation: Department of Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands.
authors.forename: R K J
authors.initials: RK
authors.lastname: Simmermacher
mesh_terms: D000328:Adult; D059350:Chronic Pain / Q000209:etiology / Q000473:pathology*; D005260:Female; D005355:Fibrosis / Q000175:diagnosis* / Q000209:etiology; D006119:Groin / Q000473:pathology / Q000601:surgery; D006552:Hernia, Inguinal / Q000601:surgery*; D059685:Herniorrhaphy / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000209:etiology / Q000473:pathology*; D013526:Surgical Mesh / Q000009:adverse effects; D055815:Young Adult
keywords: Chronic pain; Endoscopic; Inguinal hernia; MRI; TEP