Page 61 - herina surgery and possible lawsuits

incidence of chronic groin pain after Lichtenstein hernia repair without added
morbidities. It should be considered as a routine surgical step during the

operation.[122]
• Caliskan et al had found that iliohypogastric neurectomy with subcutaneous
transposition of spermatic cord decreases post operative chronic pain (PCP) without

mcrease nsk of sensory changes. [127]
There are now consensus international guidelines to preserve all three inguinal nerves during
open inguinal hernia surgery, elective resection of suspected injured nerve was

recommended, but there is no recommendation for a procedure on resected nerve
endings. [104]
Effect of mesh on nerve:

• Demirer et al in his experimental study found that ultra structural changes seen in

peripheral nerves m experimental group operated with mesh suggested that
mechanical compression of peripheral nerves is associated with myelin degeneration,
endoneunnal and perineural edema, fibrosis, axonal loss, and edema that may cause

peripheral neuropathy. Chrome groin pam after hernia repair can be possibly caused
by the entrapment of peripheral nerves in the scar tissue formed by the mesh.[128]
• Karakayali et al studied, synthetic mesh on ilioinguinal nerve motor conduction and

chronic groin pain found no significant differences on ilioinguinal nerve motor
conduction studies between the mesh and shouldice groups. They found a significant
correlation between EMG results and inguinal pain, suggest that chrome pain may be
caused by nerve injury resulting in dissection or compression of the nerves.[129]

Post operative pain in relation to time:
Pam after 1 and 4 weeks considered as early postoperative pam, and as a predictor for
chrome pam studied by very few studies.

• Callesen et al found that the risk of chrome pam was significantly higher (P<0.05) in

patients with a high early postoperative pain score compared with those with a lower
postoperative pam score after 1 and 4 weeks.[130]
• One study found that patients havmg coughing at 1 wk had significant higher nsk
(P<0.05) of developing chrome pam.[131]

• Pain persisted limited to 1 week in 23%, 2 weeks in 13%, lmonth 11%, 3 months in
8%, 1 year 3% and more than lyears in 4%.[114]

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