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Langenbeck's Archives of Surgery

Published in:

01-06-2014 | Review Article

Management of persistent postsurgical inguinal pain

Author: Mads U. Werner

Published in: Langenbeck's Archives of Surgery | Issue 5/2014

Abstract

Purpose

Severe persistent pain is a major postsurgical complication affecting 2–4 % of patients following inguinal hernia repair and may cause critical physical and socioeconomic disability. This review introduces relevant criteria and analyses the current evidence base underlying recommended management strategies.

Results

Development of persistent postsurgical pain (PPP) following inguinal hernia repair cannot automatically be considered to follow a simple trajectory from acute to chronic pain. Surgical management comprising neurectomy with or without meshectomy was described in 25 studies. Local anesthetic blocks, pharmacological management, and treatment with sensory stimulation methods were presented in seven studies. In spite of shortcomings, the data on surgical management demonstrate that neurectomy with or without mesh removal may provide long-lasting analgesic effects in most patients with severe PPP following inguinal hernia repair. The evidence base for other management methods is still fragile, although promising results appear in the neuromodulation studies.

Conclusions

There is a need for improved study designs and, launching of large multicenter collaborative studies supplying the necessary long-term data for recommendation of future management strategies.

2,000 inguinal hernia repairs per year per million inhabitants; population in Germany, 80 million.

Calculated in study_i as: follow-up weeks_i x (number of patients_i/total number of patients). Values for each study are summed up giving a weighted mean value.

Calculated in study_i as: pain relief ratio_i x (number of patients_i/total number of patients). Ratios for each study are summed up giving a weighted mean ratio.

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Title: Management of persistent postsurgical inguinal pain
Author: Mads U. Werner
Publication date: 01-06-2014
Publisher: Springer Berlin Heidelberg
Published in: Langenbeck's Archives of Surgery / Issue 5/2014
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI: https://doi.org/10.1007/s00423-014-1211-9

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Management of persistent postsurgical inguinal pain

Abstract

Purpose

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Results

Conclusions

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