Karampinis Ioannis, Weiss Johannes, Pilz Lothar, Post Stefan, Herrle Florian
Department of Surgery, Mannheim University Medical Centre, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
Department of Surgery, GRN-Klinik Schwetzingen, Schwetzingen, Germany.
BMC Surg. 2017 Jul 20;17(1):85. doi: 10.1186/s12893-017-0282-2.
Chronic debilitating pain is a rare but significant cause of postoperative morbidity after inguinal surgery. Such pain is usually of neuropathic origin and frequently caused by intraoperative nerve damage. In this retrospective matched-pair study we analysed results of a minimal-invasive approach to neurectomy on quality of life and pain relief.
From March 2010 to January 2012, 9 patients developing chronic neuropathic pain after inguinal hernia repair (8 patients) or open appendicectomy (one patient) were operated using a laparoscopic transabdominal approach in our department. Clinical examinations and specific questionnaires on pain and quality of life (PainDetect, SF-36) were completed 6 months to 3 years after neurectomy. Every patient was matched with one patient without chronic pain.
Seven of nine patients had severe or very severe pain before neurectomy, two had mild pain but refused a conservative treatment. Four patients were free of pain after neurectomy, three described an improved pain status, whereas two did not observe any change in pain. Within a follow-up period of 14,3 months, no deterioration of pain or other complications were observed. Patients who underwent neurectomy had significantly lower quality of life compared to the control group. No postoperative complications were observed.
Laparoscopic transabdominal neurectomy represents a possible surgical approach in treating patients with chronic disabling postoperative groin pain requiring surgery. This technique was feasible, safe, and effective in our series to relieve chronic debilitating pain in the majority of our patients with comparable results to other published approaches.
慢性致残性疼痛是腹股沟手术后罕见但重要的术后发病原因。这种疼痛通常源于神经病变，常由术中神经损伤引起。在这项回顾性配对研究中，我们分析了微创神经切除术对生活质量和疼痛缓解的效果。
2010年3月至2012年1月，9例腹股沟疝修补术后（8例）或开放性阑尾切除术后（1例）出现慢性神经性疼痛的患者在我科接受了腹腔镜经腹手术。神经切除术后6个月至3年完成临床检查以及关于疼痛和生活质量的特定问卷（PainDetect、SF-36）。每位患者与一名无慢性疼痛的患者配对。
9例患者中有7例在神经切除术前有严重或非常严重的疼痛，2例有轻度疼痛但拒绝保守治疗。4例患者神经切除术后无痛，3例称疼痛状况有所改善，而2例未观察到疼痛有任何变化。在14.3个月的随访期内，未观察到疼痛恶化或其他并发症。与对照组相比，接受神经切除术的患者生活质量显著较低。未观察到术后并发症。
腹腔镜经腹神经切除术是治疗需要手术的慢性致残性术后腹股沟疼痛患者的一种可能的手术方法。在我们的系列研究中，该技术可行、安全且有效，能使大多数患者的慢性致残性疼痛得到缓解，结果与其他已发表的方法相当。
