Kwee Esmee, Langeveld Mirte, Duraku Liron S, Hundepool Caroline A, Zuidam Michiel
Department of Plastic, Reconstructive Surgery and Handsurgery, Erasmus Medical Center, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands.
Department of Plastic, Reconstructive Surgery and Handsurgery, Amsterdam University Medical Center, 1105AZ Amsterdam, The Netherlands.
J Clin Med. 2024 May 10;13(10):2812. doi: 10.3390/jcm13102812.
: Neuropathic chronic postherniorrhaphy inguinal pain (CPIP) is a serious adverse outcome following inguinal hernia repair surgery. The optimal surgical treatment for neuropathic CPIP remains controversial in the current literature. This systematic review aims to evaluate the effectiveness of various surgical techniques utilized to manage neuropathic CPIP. : The electronic databases Medline, Embase, Web of Science, Cochrane Central, and Google Scholar were searched. Inclusion criteria were defined to select studies reporting on the efficacy of surgical interventions in patients with neuropathic CPIP. The primary outcome was postoperative pain relief, as determined by postoperative numerical or nonnumerical pain scores. : Ten studies met the inclusion criteria. Three surgical techniques were identified: selective neurectomy, triple neurectomy, and targeted muscle reinnervation. Proportions of good postoperative results of the surgical techniques ranged between 46 and 88 percent. Overall, the surgical treatment of neuropathic CPIP achieved a good postoperative result in 68 percent (95% CI, 49 to 82%) of neuropathic CPIP patients ( = 244), with targeted muscle reinnervation yielding the highest proportion of good postoperative results. The surgical treatment of neuropathic CPIP is generally considered safe and has demonstrated effective pain relief across various surgical techniques. Targeted muscle reinnervation exhibits considerable potential for surpassing current success rates in inguinal hernia repair surgery.
神经性腹股沟疝修补术后慢性疼痛（CPIP）是腹股沟疝修补手术后一种严重的不良后果。目前文献中，针对神经性CPIP的最佳手术治疗方法仍存在争议。本系统评价旨在评估用于治疗神经性CPIP的各种手术技术的有效性。通过检索电子数据库Medline、Embase、Web of Science、Cochrane Central和谷歌学术。纳入标准定义为选择报告手术干预对神经性CPIP患者疗效的研究。主要结局为术后疼痛缓解情况，通过术后数字或非数字疼痛评分来确定。10项研究符合纳入标准。确定了三种手术技术：选择性神经切除术、三联神经切除术和靶向肌肉再支配术。这些手术技术术后良好结果的比例在46%至88%之间。总体而言，神经性CPIP患者中，68%（95%CI，49%至82%）（n = 244）的患者接受手术治疗后取得了良好的术后效果，其中靶向肌肉再支配术术后良好结果的比例最高。神经性CPIP的手术治疗通常被认为是安全的，并且在各种手术技术中均显示出有效的疼痛缓解效果。靶向肌肉再支配术在腹股沟疝修补手术中具有超越当前成功率的巨大潜力。
