Brian P. Jacob, David C. Chen, Bruce Ramshaw, Shirin Towfigh (eds.) - The SAGES Manual of Groin Pain-Springer International Publishing (2016)

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294 K.A. Seymour and J.S. Yoo Table 22.1. Origin of postoperative pain after inguinal hernia repair. Visceral origin Vascular injury Infectious Urologic, gastrointestinal, or gynecologic disorders Somatic origin Scar tissue Meshoma Hernia recurrence Periosteal inflammation Neuropathic origin Nerve injury or entrapment Scar tissue Mesh or suture irritation Anterior and Posterior Approach Neuropathic pain involves damage or injury to the nerves of the inguinal canal, particularly nerves running in the anterior (inguinal) and posterior (preperitoneal) space. There are five sensory and somatic nerves that are susceptible to injury during inguinal hernia repair. These nerves are iliohypogastric, ilioinguinal, genital and femoral branch of the genitofemoral, and the lateral femoral cutaneous nerve. The anterior approach to repair of inguinal hernia includes the Bassini, McVay, Shouldice, and Lichtenstein repairs. These repairs may expose the nerves running in the inguinal canal (iliohypogastric, ilioinguinal, and genital branch of the genitofemoral) to injury or entrapment. Recurrence after open (anterior) inguinal hernia repair occurs in up to 6 % of patients and pain is associated with 15 % of repairs [ 9 ]. Minimally invasive inguinal hernia repair, laparoscopic transabdominal preperitoneal (TAPP) and totally extraperitoneal repair (TEP), is associated with a recurrence rate of 3 % and postoperative pain occurs after 2 % of repairs [ 9 ]. These repairs place mesh posterior to the rectus fascia, in the preperitoneal space. The “triangle of pain” is outlined as inferior to the inguinal ligaments; the apex is the internal ring, and anterolateral to the gonadal vessels [ 4 ]. The lateral femoral cutaneous nerve, femoral nerve, and femoral and genital branch of the genitofemoral nerves lie in this region [ 5 ]. Placement of tacks in the triangle of pain can inadvertently entrap the nerves.
22. Management of Inguinal Hernia Recurrences… 295 Risk Factors Pain and recurrence after inguinal hernia repair are related to a combination of patient-related risk factors, technical considerations, and operative approach. Technical errors include inadequate mesh coverage, mesh folding, and mesh migration. Burcarth et al. recommend that females undergo laparoscopic repair of inguinal hernias in order to evaluate an unappreciated femoral hernia. Smoking is associated with impaired wound healing due to hypoxia and decreased collagen formation [ 10 ]. Table 22.2 lists the preoperative, perioperative, and postoperative risk factors associated with pain after inguinal hernia repair [ 1 , 4 , 5 , 11 ]. Evaluation Evaluation of recurrence when pain is the presenting symptom after inguinal hernia repair should begin with a thorough history and physical exam. The history should include the frequency, location, and triggers of pain. The physical exam should focus on a bulge, fascial defect, and Table 22.2. Risk factors associated with pain after inguinal hernia repair. Preoperative risk factors Young age Female sex Pain prior to surgery Obesity Recurrent hernia Direct inguinal hernia Smoking Perioperative risk factors Surgeon experience Neurolysis Fixation with suture or staples Lightweight mesh Local anesthesia Excessive dissection Postoperative risk factors Recurrence Hematoma Wound infection
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Brian P. Jacob · David C. Chen Bru
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The SAGES Manual of Groin Pain Bria
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Foreword Inguinal hernia repair is
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Contents Part I Primary Groin Pain
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Contents ix 22 Management of Inguin
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Contents xi 45 Value-Based Clinical
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xiv Editors and Contributors Jeffre
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xvi Editors and Contributors David
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xviii Editors and Contributors Greg
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xx Editors and Contributors David S
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1. Introduction to Primary and Seco
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10 I.A. Gawlas and W.J. Peacock Ili
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12 I.A. Gawlas and W.J. Peacock Tra
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14 I.A. Gawlas and W.J. Peacock Var
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3. Complex Regional Pain Syndrome T
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4. Chief Complaint of Groin Pain: H
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4. Chief Complaint of Groin Pain…
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42 C. Ma and A. Ramaswamy inguinal
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44 C. Ma and A. Ramaswamy Categoriz
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46 C. Ma and A. Ramaswamy with no s
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48 C. Ma and A. Ramaswamy 26. Aasva
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50 I.M. Daoud and K. Dunn Other per
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52 I.M. Daoud and K. Dunn low herni
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54 I.M. Daoud and K. Dunn In the po
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56 I.M. Daoud and K. Dunn with a he
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58 I.M. Daoud and K. Dunn 13. O’C
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60 G.J. Mancini Occult Hernia Backg
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62 G.J. Mancini Magnetic resonance
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64 G.J. Mancini rocking motion can
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66 G.J. Mancini Unique to the adduc
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68 G.J. Mancini two nerve injuries
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70 G.J. Mancini abdominis has a rep
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72 G.J. Mancini 5. Light D, Ratnasi
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74 J.C. Campbell and G.D. Paiement
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9. Groin Pain Etiology: Spine and B
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10. Groin Pain Etiology: Spermatic
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Table 10.2. European Association of
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138 M. Hibner and C. Coyne Piriform
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140 M. Hibner and C. Coyne Fig. 11.
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142 M. Hibner and C. Coyne Table 11
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144 M. Hibner and C. Coyne present
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146 M. Hibner and C. Coyne Table 11
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148 M. Hibner and C. Coyne Once the
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150 M. Hibner and C. Coyne 3. Hibne
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12. Chronic Pelvic Pain in Women M.
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12. Chronic Pelvic Pain in Women 15
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174 J.M. Miller et al. Knowing the
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176 J.M. Miller et al. Fig. 13.2. A
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182 J.M. Miller et al. Fig. 13.9. C
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184 J.M. Miller et al. Fig. 13.14.
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192 J.M. Miller et al. Cardiac Cath
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194 B.J. Dunkin Noxious peripheral
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196 B.J. Dunkin Table 14.1. Summary
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198 B.J. Dunkin Rectus abdominis Ex
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200 B.J. Dunkin COX-1 COX-2 Celecpx
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202 B.J. Dunkin Table 14.2. Common
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204 B.J. Dunkin Possible Preoperati
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206 B.J. Dunkin Postoperative Pain
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208 B.J. Dunkin Summary Understandi
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15. Chronic Groin Pain Following An
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222 E.L. Felix not seem to alter th
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224 E.L. Felix nerves from the surg
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226 E.L. Felix Fig. 16.2. Lateral f
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228 E.L. Felix It has been establis
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230 E.L. Felix 18. Pollak R, Nyhus
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17. The Orthopedic Perspective on G
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Page 252 and 253: 17. The Orthopedic Perspective on G
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26. Chronic Orchialgia: Workup and
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27. The Role of Bioactive Prostheti
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376 G. Campanelli et al. affecting
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378 G. Campanelli et al. into the w
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380 G. Campanelli et al. chronic gr
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382 G. Campanelli et al. A prospect
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384 G. Campanelli et al. open mesh
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386 G. Campanelli et al. 38. Alfier
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29. Prevention of Pain: Optimizing
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30. Prophylactic Neurectomy Versus
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Table 31.1. Selective neurectomy wi
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408 W.M.J. Reinpold and A.D. Schroe
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32. Chronic Groin Pain: Mesh or No
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Part IV Case Reports and Patients
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430 S. Towfigh were irregular and s
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432 S. Towfigh in addressing her sy
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434 S. Towfigh Conclusion We have y
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436 K.W. Kercher Physical Examinati
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438 K.W. Kercher Fig. 34.4. Left ad
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440 K.W. Kercher Fig. 34.5. After d
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442 K.W. Kercher the posterior wall
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444 K.W. Kercher Table 34.2. Surgic
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35. Chronic Post-inguinal Herniorrh
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35 Chronic Post-inguinal Herniorrha
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35 Chronic Post-inguinal Herniorrha
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36. Sports Hernia with Adductor Ten
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464 C.G. DuCoin and G.R. Jacobsen P
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466 C.G. DuCoin and G.R. Jacobsen O
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468 J.A. Blatnik and A.S. Prabhu a
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470 J.A. Blatnik and A.S. Prabhu Fi
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472 J.A. Blatnik and A.S. Prabhu ma
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474 S. Towfigh Physical Exam The pa
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476 S. Towfigh The patient’s loca
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478 S. Towfigh Fig. 39.2. Diagram o
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480 S. Towfigh periphery. He is 2+
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482 S. Towfigh References 1. Matthi
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484 N.A. Al-Enazi and B.P. Jacob
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486 N.A. Al-Enazi and B.P. Jacob Fi
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488 N.A. Al-Enazi and B.P. Jacob pu
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42. Patient with Chronic Pelvic Pai
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42. Patient with Chronic Pelvic Pai
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43. Thoracolumbar Syndrome James A.
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43. Thoracolumbar Syndrome 497 The
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43. Thoracolumbar Syndrome 499 Groi
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44. Patient with Referred Hip Pain
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44. Patient with Referred Hip Pain
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45. Value-Based Clinical Quality Im
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46. Patient Care Manager Perspectiv
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47. Workers’ Compensation: An Occ
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532 Index Athletic pubalgia (cont.)
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534 Index Chronic post-herniorrhaph
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536 Index Groin pain (cont.) magnet
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538 Index Ilioinguinal nerve (IIN)
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540 Index Local anesthetics (cont.)
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542 Index Peripheral nerve entrapme
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544 Index S Sacroiliac (SI) joint d
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546 Index Transperineal pudendal ne
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Brian P. Jacob, David C. Chen, Bruce Ramshaw, Shirin Towfigh (eds.) - The SAGES Manual of Groin Pain-Springer International Publishing (2016)

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