Page 59 - herina surgery and possible lawsuits

• Poobalan et al. had found chronic pain in 35% patients having pre operative pain,
compare to only 7% patients having no preoperative pain, stated significant predictive
value (P<0.005) between preoperative and chronic pain.[l 17]

• In contrast, Liem et al. had found no significant relation between them (P=0.2).[l 19]
• Page et al. had studied pain from primary inguinal hernia and the effect of repair on
pain, showed that hernia surgery reduced the preoperative pain but some of the

patients develop pain at the operative site which was not preoperatively present. In
contrast, other study had found that 30% of the patients reported no change in pain
from before surgery and 5% had worse pain than before surgery,[14,120]

Type of Anesthesia;

• Despite sufficient scientific data to support the local anesthesia, large epidemiologic

and nationwide information from databases show high use of spinal anesthesia and
low use of local infiltration anesthesia. [69]

• Alfieri et al. had reported moderate to severe pain at 6 months around 2.0% m each
form of local, general and spinal/ epidural anesthesia (P=0.89).[15]

Influence of Snerves on chronic pain:

• Most of the researchers agreed that the nerves of inguinal canal plays major role m
chrome pain, so it required recognition of anatomy of the ilioinguinal, iliohypogastric,
and genitofemoral nerves along with their variations.

• The practice of identification of all 3 nerves is quite poor. Ravindran et al conducted a
survey in the United Kingdom regarding the handling of inguinal nerves during open
hernia repair and showed that ilioinguinal nerve (IIN ) was routinely identified by

88% of surgeons, iliohypogastric nerve (IHN) by 58% and genitofemoral nerve
(GFN) by 54%. The individual nerves were routinely divided by 7%, 5% and 6% of
surgeons, respectively.[121]

There was no definite consensus available on routine identification of inguinal nerves and
preservation or division. The survey also pointed out that those surgeons who performed
more than 50 hernias per year were more likely to preserve the nerve and others were more
likely to ignore it [122]

There are various studies for nerve identification, isolation, preservation and division but
many contrary views have emerged. There are studies favor identification, isolation and
preservation of nerves,[43] others found no added advantage of nerve preservation or division

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