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Hernia
Published in: Hernia 1/2015

01-02-2015 | Original Article

An international consensus algorithm for management of chronic postoperative inguinal pain

Authors: J. F. M. Lange, R. Kaufmann, A. R. Wijsmuller, J. P. E. N. Pierie, R. J. Ploeg, D. C. Chen, P. K. Amid

Published in: Hernia | Issue 1/2015

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Abstract

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.
Appendix
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Metadata
Title
An international consensus algorithm for management of chronic postoperative inguinal pain
Authors
J. F. M. Lange
R. Kaufmann
A. R. Wijsmuller
J. P. E. N. Pierie
R. J. Ploeg
D. C. Chen
P. K. Amid
Publication date
01-02-2015
Publisher
Springer Paris
Published in
Hernia / Issue 1/2015
Print ISSN: 1265-4906
Electronic ISSN: 1248-9204
DOI
https://doi.org/10.1007/s10029-014-1292-y

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