American Society for Peripheral Nerve
ASPN Home ASPN Home Past & Future Meetings Past & Future Meetings

Back to 2023 Posters


Inguinal Neuritis and Neuromas: A Major Cause of Chronic Pain after Inguinal Hernia Repairs, single-surgeon experience
Alexa De la Fuente Hagopian, MD1; Souha Farhat, MD1; Sebastian Guadarrama-Sistos Vazquez, MD2; Narainsai K Reddy, MS3; Anthony Echo, MD?
1Houston Methodist Hospital, Houston, TX; 2Baylor College of Medicine, Houston, TX; 3Texas A&M, Houston, TX; 4Houston Methodist Hospital, Weill Cornell Medicine, Houston, TX

Introduction Roughly 800,000 inguinal hernia repairs are performed in the US annually1. Overall, the incidence of clinically significant chronic pain ranges from 15-40%3,4.
While this percentage may vary depending on the technique performed, open mesh repairs are one of the main causes of injury to one or more of the three inguinal nerve branches.
Methods A retrospective review was performed on 6 patients who underwent inguinal mesh removal and triple denervation of the groin in 2021. The pre-operative exams demonstrated nerve pain in the inguinal floor reproducible with palpation. MRI- neurography demonstrated inflammation of the inguinal nerves in all 6 patients and the patients had temporary relief from an inguinal nerve block.
All 6 patients had surgical exploration of the inguinal canal which demonstrated extensive scarring of the ilioinguinal, iliohypogastric, and genitofemoral nerves to the mesh. Results The patients were male between the ages of 42-69. The initial hernia repair was an average of 16 years prior, and the onset of pain was 9 years prior to consultation. The mean pre-operative VAS was 10/10, the post-operative VAS was 2/10 by 6 months.
All nerves had extensive scarring and were transected and buried in the muscle or pre-peritoneal fat. Complete or near-complete removal of mesh was performed. The inguinal floor was then reconstructed with a tissue repair or biologic mesh.
Conclusions Triple denervation and mesh excision as last resource treatment for patients with chronic post mesh herniorrhaphy inguinal pain is a viable and necessary option with minimal postoperative complications.
Reference

  1. Hammoud M, Gerken J. Inguinal Hernia. [Updated 2021 Aug 22]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK513332/
  2. Andresen K, Rosenberg J. Management of chronic pain after hernia repair. J Pain Res. 2018 Apr 5;11:675-681. doi: 10.2147/JPR.S127820. PMID: 29670394; PMCID: PMC5896652.
  3. Nikkolo C, Lepner U. Chronic pain after open inguinal hernia repair. Postgrad Med. 2016 Jan;128(1):69-75. doi: 10.1080/00325481.2016.1121090. Epub 2015 Dec 4. PMID: 26567717.
  4. Bande, D., Moltó, L., Pereira, J.A. et al. Chronic pain after groin hernia repair: pain characteristics and impact on quality of life. BMC Surg 20, 147 (2020). https://doi.org/10.1186/s12893-020-00805-9

Back to 2023 Posters