Page 66 - herina surgery and possible lawsuits

They suggested that majority of the patients are treated successfully with therapeutic

injection in to the point of maximal tendemess.[145]
• Amid suggests that many cases the pain may be debilitating and ends in re-
exploration of the wound and division of the three nerves is desirable. [46]

• Aasvang et al in 2005 reviewed papers the surgical options of mesh removal, stitch
removal and neurectomy for management of chronic pain and found that neurectomy
have reported favourable outcome, and insufficient information was available for

effect of mesh or stitch/staple removal. They also found that all study were poorly
designed in respect of preoperative diagnostic criteria, intraoperative success in
identifying a pathological lesion or nerve and quality of follow up. [146] They design

preoperative criteria of > 1 year pain related impairment of daily activities and well
localization of maximum pain point, intraoperative removal of mesh and selective
neurectomy in cases of macroscopic nerve injury and validated outcome with pre and

post operative quantitative sensory testing. They concluded that said procedure
improves pain related impairment. [147]
Treatment for persistent chrome neuralgia after inguinal hemioplasty should follow a step-

by-step therapeutic protocol. In the initial phase, patients treated with oral analgesic and
afterwards with repeated infiltrations of anesthetic and cortisone. The noninvasive methods
are to be preferred, whereas neurectomy interventions reserved for selected cases. [148]

Recurrence of hernia
• Malik in his comparative analysis between non-mesh (Bassini's) and mesh
(Lichtenstein) repair of primary inguinal hernia recurrence occurred in 2.0% out of

392 patients those with Lichtenstein mesh repair, on the other hand 7.1% patients with
Bassini's repair reported recurrence within 3 years time.[136]
• Haapaniem found recurrent henna reoperation in 4.6% after recurrent hernia repair

and 1.7% after primary hernia repair at 24 months.[149]
• Neumayer et al in multicentre trails of 2164 patients with 85% follow up for 2 years
had higher recurrence in laparoscopic patients 10.1% than open repair 4.9%.[135]

• Liem found recurrences rate 3.8% at 2 years and 4.9% at 4 years in the laparoscopic
group, and 6.3% and 10 0% in the open surgery group (P=(7006).[l 19]
• Martin has reported that Lichtenstein hemioplasty had recurrence rate of 0.5%.[150]

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