Huy Tess C, Lu Yang, Weitzner Zachary, Lau Stephanie W, DeJesus Melissa S, Hu Theodore, MacQueen Ian T, Chen David C
Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California.
Department of Surgery, Kaiser Permanente, Santa Clara, California.
JAMA Surg. 2025 Jul 30. doi: 10.1001/jamasurg.2025.2502.
With a decrease in recurrence since modern hernia repair, chronic postoperative inguinal pain is the most important patient-centered outcome. Surgical intervention is often necessary in cases refractory to conservative measures but remains understudied.
To evaluate causes of refractory chronic postoperative inguinal pain and review the operative approaches used to treat patients who experience it.
DESIGN, SETTING, AND PARTICIPANTS: This case series used electronic medical record data from a single-institution hernia center during the period August 1, 2009, to September 17, 2024. Participants were adult patients who underwent surgery for chronic postoperative inguinal pain; those who underwent surgeries during which the inguinal canal was not entered or involved were excluded. Patients were followed up from their remedial surgery date to their most recent surgeon follow-up visit date.
Remedial surgical approach (laparoscopic, robotic, open, combined), use of mesh, nerve management, and mesh excision.
The primary outcome was subjective pain improvement after remedial surgery; other outcomes were postoperative complications and need for additional operations.
A total of 818 adult patients underwent surgery for chronic postoperative inguinal pain (median [IQR] age, 53 [42-64] years; 193 [23.6%] were female and 625 [76.4%] male). Among them, 779 patients (95.2%) underwent previous inguinal repair with nearly half (49.3%) undergoing 2 or more surgeries. Of remedial surgeries, 221 (27.0%) were open alone, 113 (13.8%) were laparoscopic alone, 57 (7.0%) were robotic alone, 349 (42.7%) were hybrid open and laparoscopic, and 78 (9.5%) were hybrid open and robotic. Seven hundred thirty patients (89.2%) underwent a neurectomy, with triple neurectomies in 401 surgeries (54.9%). Mesh was removed in 559 patients (68.3%). Among patients with at least 5 days of postoperative follow-up, inguinal pain improved in 798 patients (98.5%), with 560 patients (70.2%) reporting more than a 50% reduction in inguinal pain and 226 (28.3%) reporting a 50% or smaller improvement. Twelve patients (1.5%) had no significant improvement in subjective pain. Forty-two patients (5.1%) experienced complications.
Chronic postoperative inguinal pain is a common, debilitating complication of inguinal hernia repair. Remedial surgery is complex, but tailored surgical approaches that consider neurectomy, mesh excision, and recurrent inguinal hernia repair can be safe and effective in experienced centers.
随着现代疝修补术后复发率的降低，慢性术后腹股沟疼痛成为以患者为中心的最重要结局。对于保守治疗无效的病例，手术干预往往是必要的，但这方面的研究仍不充分。
评估难治性慢性术后腹股沟疼痛的原因，并回顾用于治疗此类患者的手术方法。
设计、地点和参与者：本病例系列使用了2009年8月1日至2024年9月17日期间一家单一机构疝中心的电子病历数据。参与者为接受慢性术后腹股沟疼痛手术的成年患者；排除腹股沟管未被进入或未受影响的手术患者。从补救手术日期至患者最近一次外科医生随访日期对患者进行随访。
补救手术方法（腹腔镜、机器人辅助、开放、联合）、补片使用、神经处理和补片切除。
主要结局是补救手术后主观疼痛改善；其他结局是术后并发症和再次手术需求。
共有818例成年患者接受了慢性术后腹股沟疼痛手术（年龄中位数[四分位间距]为53[42 - 64]岁；女性193例[23.6%]，男性625例[76.4%]）。其中，779例患者（95.2%）曾接受过腹股沟修补术，近一半（49.3%）接受过2次或更多次手术。在补救手术中，单纯开放手术221例（27.0%），单纯腹腔镜手术113例（13.8%），单纯机器人辅助手术57例（7.0%），开放与腹腔镜联合手术349例（42.7%），开放与机器人辅助联合手术78例（9.5%）。730例患者（89.2%）接受了神经切除术，401例手术（54.9%）进行了三联神经切除术。559例患者（68.3%）切除了补片。在术后至少随访5天的患者中，798例患者（98.5%）腹股沟疼痛得到改善，560例患者（70.2%）报告腹股沟疼痛减轻超过50%，226例患者（28.3%）报告改善程度为50%或更小。12例患者（1.5%）主观疼痛无明显改善。42例患者（5.1%）出现并发症。
慢性术后腹股沟疼痛是腹股沟疝修补术常见且使人衰弱的并发症。补救手术复杂，但在经验丰富的中心，考虑神经切除术、补片切除和复发性腹股沟疝修补的个体化手术方法可能安全有效。
