Mesh Removal and Selective Neurectomy for Persistent Groin Pain following Lichtenstein Repair

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W. Zwaans, C. Perquin, R. Roumen, M. Scheltinga

Moderator(s): Henk Ten Cate Hoedemaker (Groningen, The Netherlands) & Harry van Goor (Nijmegen, The Netherlands)

13:00 - 13:10h at Jurriaanse Zaal

Categories: Session 7. Innovative techniques and future perspectives

Parallel session: Session 7. Innovative techniques and future perspectives

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Background:
Some patients with persistent inguinodynia following Lichtenstein repair fail all non-surgical pain treatments. Mesh removal is controversial as surgeons expect a difficult operation. Once mesh is removed, a recurrent hernia may be looming. Studies reporting on pain relief and complications after mesh removal are scarce. The present study investigates the long term effects of mesh removal for inguinodynia following Lichtenstein repair.

Study design:
Adult patients (n=215) undergoing open surgery for chronic inguinodynia following Lichtenstein repair performed between 2000 and 2013 were identified via an operative database. Consecutive patients (n=60; 53 males, mean age 56 years) who underwent mesh removal with (n=44) or without (n=16) selective neurectomy were eligible for analysis. A questionnaire study was performed after a median 21 month follow-up in these patients. Outcome measures were pain relief using a numerical rating score, postoperative complications, time to recovery and hernia recurrence rate. Success was defined as a ≥50% pain relief.

Results:
The surgical procedure resulted in a significant 5.8 drop in median pain score (7.8, range 4.0-10.0 versus 2.0, range 0.0-9.0, p<0.001). Success was attained in two thirds of patients, and 95% of these were pain free after a six month postoperative time period. Complications included testicular atrophy (n=2) and small bowel injury (n=1). Two hernia recurrences occurred during follow-up.

Conclusions:
Mesh removal combined with selective neurectomy should be considered in patients with chronic inguinodynia following Lichtenstein hernia repair who are unresponsive to previous pain treatments.