Page 55 - herina surgery and possible lawsuits

• Because of these major understanding, the chrome groin pain after hernia surgery-

have been classified as neuropathic cause due to inguinal nerve(s) damage or non-
neuropathic cause due to mesh or other related factors.
• The groin hernia repair with a mesh implant can lead to chronic nociceptive pain due

to the continuous inflammation around the mesh. However, so far no study has clearly
differentiated neuropathic pathogenesis from inflammatory pathogenesis. Since the
mesh inflammation itself can lead to nerve damage, it is difficult to clearly

differentiate chronic neuropathic from nociceptive pain following groin hernia repair,
although nerve damage seems to be prerequisite for development of chrome
pam.[104]
Chevrel has described four types of neuralgias for post hernia repair: f 6]

Neuroma pain: The most common type, it was caused by proliferation of nerve fibers outside
the neunlemma following complete or partial nerve section. Hyperesthesia is seen

along the corresponding dermatome. Pain is exquisite at the site of neuroma and
simulates an electric shock.
Deafferentation pain: A burning pain following partial or complete nerve section or
entrapment m a ligature with chronic paroxysmal exacerbations. Initially, an area of

anesthesia followed by adjacent areas of hypoesthesia, then hyperesthesia and
contact dysesthesia in the corresponding dermatome.
Projected pain The intact nerve is encased in a callus or entrapped m a ligature. Pain is

elicited by light touch along the course of the nerve
Referred vain: The lesion is at a distance such as an inflammatory granuloma around a suture
or the stump of a peritoneal sac.

Therefore, studies are m progress based on well-defined neuro-physiological
assessments to identify sub-groups with different types of neuroplasticity (wmd-up
phenomena, aliodynia, reduced pressure pain thresholds, hypoesthesia, etc.), which

hopefully will be able to identify patients who can be re-operated versus those requiring
pharmacological treatment. [104]
Tools (methods) of pain assessment:
The symptom complex of chronic groin pam vanes from a dull ache to sharp shooting

pam along the distnbution of inguinal nerves. There is no single test to confirm the
etiology behind the pain or to point out the exact nerve involved.

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