Heise C P, Starling J R
Department of Surgery, University of Wisconsin Hospital and Clinics, Madison, USA.
J Am Coll Surg. 1998 Nov;187(5):514-8. doi: 10.1016/s1072-7515(98)00215-4.
Chronic inguinodynia or neuralgia after conventional inguinal herniorrhaphy is rare, and diagnosing the exact cause is difficult. Treatment has ranged from local injection to remedial surgery with variable results. The increasing popularity of prosthetic mesh repairs (tension free, plug, or laparoscopic) has not eliminated these pain syndromes from occasionally occurring. Recommended management in these situations is extremely difficult.
Since 1994, 117 inguinal reexplorations have been performed for inguinodynia and 20 of these patients had primary mesh herniorrhaphy. All 20 patients had mesh removal. Records were reviewed and patients contacted to evaluate outcomes.
All 20 patients were evaluated (15 by telephone or direct contact, 5 by chart review). Three patients had their initial repair performed laparoscopically. Symptoms persisted for 12.2 +/- 1.7 months before remedial surgery. Four patients underwent inguinal reexploration and mesh removal; 16 had mesh removal plus ilioinguinal or iliohypogastric neurectomy. Good to excellent results were achieved in 12 out of 20 patients (60%). Average followup time was 15.9 +/- 3.1 months. Two of 3 patients who had laparoscopic herniorrhaphy had favorable outcomes (67%). Ten of the 16 patients who had mesh removal plus neurectomy reported good to excellent results (62%) compared with 2 of 4 reporting the same with mesh excision only (50%). Eleven patients had pain relief with preoperative nerve block. Of these, 9 had elective neurectomy resulting in good to excellent results in 5 (56%).
Remedial inguinal exploration and mesh removal with or without neurectomy resulted in favorable outcomes in 60% of patients with mesh herniorrhaphy chronic inguinodynia (neuralgia). It appears that coincident neurectomy affords better results than mesh removal alone. Relief with nerve block did not predict favorable outcomes. Despite the popularity and favorable outcomes of prosthetic mesh repairs, persistent postoperative pain still occurs in a small cohort of patients. This may become more evident with the rising interest in laparoscopy. Correcting this problem once presented can be a formidable task. Remedial inguinal surgery with mesh removal and neurectomy will cure selected patients.
传统腹股沟疝修补术后出现慢性腹股沟疼痛或神经痛的情况较为罕见，准确诊断病因也很困难。治疗方法从局部注射到补救性手术不等，效果各异。人工补片修补术（无张力修补、补片修补或腹腔镜修补）日益普及，但这些疼痛综合征仍偶尔会出现。在这些情况下，推荐的治疗方案极难确定。
自1994年以来，因腹股沟疼痛进行了117例腹股沟再次探查手术，其中20例患者接受了初次补片疝修补术。所有20例患者均接受了补片取出术。回顾病历并联系患者以评估治疗效果。
对所有20例患者进行了评估（15例通过电话或直接联系，5例通过查阅病历）。3例患者最初接受的是腹腔镜修补术。在补救性手术前，症状持续了12.2±1.7个月。4例患者接受了腹股沟再次探查和补片取出术；16例患者接受了补片取出术加髂腹股沟或髂腹下神经切除术。20例患者中有12例（60%）取得了良好至极佳的效果。平均随访时间为15.9±3.1个月。3例接受腹腔镜疝修补术的患者中有2例取得了良好的效果（67%）。16例接受补片取出术加神经切除术的患者中有10例（62%）报告效果良好至极佳，而仅接受补片切除术的4例患者中有2例（50%）报告效果相同。11例患者术前神经阻滞疼痛缓解。其中9例接受了选择性神经切除术，5例（56%）效果良好至极佳。
补救性腹股沟探查及补片取出术，无论是否加做神经切除术，在60%的补片疝修补术后慢性腹股沟疼痛（神经痛）患者中取得了良好的效果。似乎同时进行神经切除术比单纯取出补片效果更好。神经阻滞缓解疼痛并不能预测良好的治疗效果。尽管人工补片修补术很受欢迎且效果良好，但一小部分患者术后仍会持续疼痛。随着对腹腔镜手术兴趣的增加，这一问题可能会更加明显。一旦出现这个问题，纠正起来可能是一项艰巨的任务。补救性腹股沟手术加补片取出术和神经切除术可治愈部分患者。
