Keller Jennifer E, Stefanidis Demitrios, Dolce Charles J, Iannitti David A, Kercher Kent W, Heniford B Todd
Division of Gastrointestinal and Minimally Invasive Surgery, Carolinas Medical Center, Charlotte, North Carolina 28203, USA.
Am Surg. 2008 Aug;74(8):695-700; discussion 700-1.
Chronic groin pain is the most frequent long-term complication after inguinal hernia repair affecting up to 34 per cent of patients. Traditional surgical management includes groin exploration, mesh removal, and neurectomy. We evaluate outcomes of a combined laparoscopic and open approach to chronic pain after inguinal herniorrhaphy. All patients undergoing surgical exploration for chronic pain after inguinal herniorrhaphy were analyzed. In most, the operation consisted of mesh removal (open or laparoscopic), neurectomy, and placement of mesh in the opposite location of the first mesh (laparoscopic if the first was open and vice-versa). Main outcome measures included pain status, numbness, and hernia recurrence. Twenty-one patients (16 male and 5 female) with a mean age of 41 years (22-51 years) underwent surgical treatment for unilateral (n = 18) or bilateral (n = 3) groin pain. Percutaneous nerve block was unsuccessful in all patients. Four had previous surgery for pain. There were no complications. With a minimum of 6 weeks follow-up, 20 of 21 patients reported significant improvement or resolution of symptoms. A combined laparoscopic and open approach for postherniorrhaphy groin pain results in excellent patient satisfaction with minimal morbidity. It may be the preferred technique for the definitive management of chronic neuralgia after hernia repair.
慢性腹股沟疼痛是腹股沟疝修补术后最常见的长期并发症，影响高达34%的患者。传统的手术治疗包括腹股沟探查、补片移除和神经切除术。我们评估了腹股沟疝修补术后慢性疼痛的腹腔镜与开放联合治疗方法的效果。对所有因腹股沟疝修补术后慢性疼痛接受手术探查的患者进行了分析。大多数情况下，手术包括补片移除（开放或腹腔镜）、神经切除术，以及在第一个补片相反位置放置补片（如果第一个是开放的则采用腹腔镜方式，反之亦然）。主要观察指标包括疼痛状况、麻木和疝复发。21例患者（16例男性和5例女性），平均年龄41岁（22 - 51岁），接受了单侧（n = 18）或双侧（n = 3）腹股沟疼痛的手术治疗。所有患者经皮神经阻滞均未成功。4例曾因疼痛接受过手术。无并发症发生。经过至少6周的随访，21例患者中有20例报告症状显著改善或缓解。腹股沟疝修补术后腹股沟疼痛的腹腔镜与开放联合治疗方法使患者满意度极高，且发病率极低。它可能是疝修补术后慢性神经痛确定性治疗的首选技术。
