An international consensus algorithm for management of chronic postoperative inguinal pain

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• 作者：J. F. M. Lange (1)
  R. Kaufmann (2)
  A. R. Wijsmuller (2)
  J. P. E. N. Pierie (3) (4)
  R. J. Ploeg (1) (5)
  D. C. Chen (6)
  P. K. Amid (6)
  
  1. Department of Surgery ; University Medical Center Groningen ; Groningen ; The Netherlands
  2. Department of Surgery ; Erasmus Medical Center Rotterdam ; Rotterdam ; The Netherlands
  3. Department of Surgery ; Medical Center Leeuwarden ; Leeuwarden ; The Netherlands
  4. Postgraduate School of Medicine ; University Groningen ; Groningen ; The Netherlands
  5. Nuffield Department of Surgical Sciences ; University of Oxford ; Oxford ; UK
  6. Department of Surgery ; David Geffen School of Medicine at UCLA and Lichtenstein Amid Hernia Clinic at UCLA ; Los Angeles ; CA ; USA
  
• 关键词：Chronic pain ; Inguinal hernia ; Lichtenstein ; Neurectomy ; CPIP ; Chronic postoperative inguinal pain
• 刊名：Hernia
• 出版年：2015
• 出版时间：February 2015
• 年：2015
• 卷：19
• 期：1
• 页码：33-43
• 全文大小：413 KB
• 参考文献：1. Franneby U, Sandblom G, Nordin O et al (2006) Risk factors for long-term pain after hernia surgery. Ann Surg 244:212鈥?19 CrossRef
  2. Bay-Nielsen M, Nilsson E, Nordin P, Kehlet H (2004) Swedish Hernia Data Base the Danish Hernia Data B. Chronic pain after open mesh and sutured repair of indirect inguinal hernia in young males. Br J Surg 91(10):1372鈥?376 CrossRef
  3. Callesen T, Bech K, Kehlet H (1999) Prospective study of chronic pain after groin hernia repair. Br J Surg 86(12):1528鈥?531 CrossRef
  4. Cunningham J, Temple WJ, Mitchell P, Nixon JA, Preshaw RM, Hagen NA (1996) Cooperative hernia study. Pain in the postrepair patient. Ann Surg 224(5):598鈥?02 CrossRef
  5. Holzheimer RG (2007) Low recurrence rate in hernia repair鈥搑esults in 300 patients with open mesh repair of primary inguinal hernia. Eur J Med Res 12(1):1鈥?
  6. Mikkelsen T, Werner MU, Lassen B, Kehlet H (2004) Pain and sensory dysfunction 6 to 12聽months after inguinal herniotomy. Anesth Analg 99(1):146鈥?51 CrossRef
  7. Vironen J, Nieminen J, Eklund A, Paavolainen P (2006) Randomized clinical trial of Lichtenstein patch or Prolene Hernia System for inguinal hernia repair. Br J Surg 93(1):33鈥?9 CrossRef
  8. Kehlet H, Jensen TS, Woolf CJ (2006) Persistent postsurgical pain: risk factors and prevention. Lancet 367(9522):1618鈥?625 CrossRef
  9. Kehlet H (2008) Chronic pain after groin hernia repair. Br J Surg 95(2):135鈥?36 CrossRef
  10. Alfieri S, Amid PK, Campanelli G et al (2011) International guidelines for prevention and management of post-operative chronic pain following inguinal hernia surgery. Hernia 15(3):239鈥?49 CrossRef
  11. Heise CP, Starling JR (1998) Mesh inguinodynia: a new clinical syndrome after inguinal herniorrhaphy? J Am Coll Surg 187(5):514鈥?18 CrossRef
  12. Masukawa K, Wilson SE (2010) Is postoperative chronic pain syndrome higher with mesh repair of inguinal hernia? Am Surg 76(10):1115鈥?118
  13. Miller JP, Acar F, Kaimaktchiev VB, Gultekin SH, Burchiel KJ (2008) Pathology of ilioinguinal neuropathy produced by mesh entrapment: case report and literature review. Hernia 12(2):213鈥?16 CrossRef
  14. Yavuz A, Kulacoglu H, Olcucuoglu E et al (2011) The faith of ilioinguinal nerve after preserving, cutting, or ligating it: an experimental study of mesh placement on inguinal floor. J Surg Res 171(2):563鈥?70 CrossRef
  15. Amid PK (2004) Lichtenstein tension-free hernioplasty: its inception, evolution, and principles. Hernia 8(1):1鈥? CrossRef
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  17. Aasvang EK, Kehlet H (2009) The effect of mesh removal and selective neurectomy on persistent postherniotomy pain. Ann Surg 249(2):327鈥?34 CrossRef
  18. Amid PK, Chen DC (2011) Surgical treatment of chronic groin and testicular pain after laparoscopic and open preperitoneal inguinal hernia repair. J Am Coll Surg 213(4):531鈥?36 CrossRef
  19. Amid PK (2004) Radiologic images of meshoma: a new phenomenon causing chronic pain after prosthetic repair of abdominal wall hernias. Arch Surg 139(12):1297鈥?298 CrossRef
  20. Inaba T, Okinaga K, Fukushima R et al (2012) Chronic pain and discomfort after inguinal hernia repair. Surg Today 42(9):825鈥?29 CrossRef
  21. Nienhuijs S, Staal E, Strobbe L, Rosman C, Groenewoud H, Bleichrodt R (2007) Chronic pain after mesh repair of inguinal hernia: a systematic review. Am J Surg 194(3):394鈥?00 CrossRef
  22. Jones JH (1995) Education and debate: qualitative research: consensus methods for medical and health services research. BMJ 311:376鈥?80 CrossRef
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  24. Chen DC, Hiatt JR, Amid PK (2013) Operative management of refractory neuropathic inguinodynia by a laparoscopic retroperitoneal approach. JAMA Surg 148(10):962鈥?67 CrossRef
  25. Amid PK, Chen DC (2011) Surgical treatment of chronic groin and testicular pain after laparoscopic and open inguinal hernia repair. J Am Coll Surg 213(4):531鈥?36 CrossRef
  26. Song JW, Wolf JS Jr, McGillicuddy JE, Bhangoo S, Yang LJ (2011) Laparoscopic triple neurectomy for intractable groin pain: technical report of 3 cases. Neurosurgery 68(2):339鈥?46
  27. Amid PK, Hiatt RH (2007) New understanding of the causes and surgical treatment of postherniorrhaphy inguinodynia and orchalgia. J Am Coll Surg 205(2):381鈥?85 CrossRef
  28. Lichtenstein IL, Shulman AG, Amid PK, Montllor MM (1988) Cause and prevention of postherniorrhaphy neuralgia: a proposed protocol for treatment. Am J Surg 155(6):786鈥?90 CrossRef
  29. Chen DC, Amid PK (2013) Persistent orchialgia after inguinal hernia repair: diagnosis, neuroanatomy, and surgical management: Invited comment to: Role of orchiectomy in severe testicular pain and inguinal hernia surgery: audit of Finnish patient insurance centre R枚nka K, Vironen J, Kokki H, Liukkonen T, Paajanen H. Hernia. doi:10.1007/s10029-013-1150-3 [Epub ahead of print]
  
• 刊物类别：Medicine
• 刊物主题：Medicine & Public Health
  Abdominal Surgery
  
• 出版者：Springer Paris
• ISSN：1248-9204

文摘

Purpose Tension-free mesh repair of inguinal hernia has led to uniformly low recurrence rates. Morbidity associated with this operation is mainly related to chronic pain. No consensus guidelines exist for the management of this condition. The goal of this study is to design an expert-based algorithm for diagnostic and therapeutic management of chronic inguinal postoperative pain (CPIP). Methods A group of surgeons considered experts on inguinal hernia surgery was solicited to develop the algorithm. Consensus regarding each step of an algorithm proposed by the authors was sought by means of the Delphi method leading to a revised expert-based algorithm. Results With the input of 28 international experts, an algorithm for a stepwise approach for management of CPIP was created. 26 participants accepted the final algorithm as a consensus model. One participant could not agree with the final concept. One expert did not respond during the final phase. Conclusion There is a need for guidelines with regard to management of CPIP. This algorithm can serve as a guide with regard to the diagnosis, management, and treatment of these patients and improve clinical outcomes. If an expectative phase of a few months has passed without any amelioration of CPIP, a multidisciplinary approach is indicated and a pain management team should be consulted. Pharmacologic, behavioral, and interventional modalities including nerve blocks are essential. If conservative measures fail and surgery is considered, triple neurectomy, correction for recurrence with or without neurectomy, and meshoma removal if indicated should be performed. Surgeons less experienced with remedial operations for CPIP should not hesitate to refer their patients to dedicated hernia surgeons.