MESH INGUINODYNIA - A NEW CLINICAL SYNDROME AFTER INGUINAL HERNIORRHAPHY

Background: Chronic inguinodynia or neuralgia after conventional ingui nal herniorrhaphy is rare, and diagnosing the exact cause is difficult . Treatment has ranged from local injection to remedial surgery with v ariable results. The increasing popularity of prosthetic mesh repairs (tension free, plug, or laparoscopic) has not eliminated these pain sy ndromes from occasionally occurring. Recommended management in these s ituations is extremely difficult. Study Design: Since 1994, 117 inguin al reexplorations have been performed for inguinodynia and 20 of these patients had primary mesh herniorrhaphy. ALL 20 patients had mesh rem oval. Records were reviewed and patients contacted to evaluate outcome s. Results: All 20 patients were evaluated (15 by telephone or direct contact, 5 by chart review). Three patients had their initial repair p erformed laparoscopically. Symptoms persisted for 12.2 +/- 1.7 months before remedial surgery. Four patients underwent inguinal reexploratio n and mesh removal; 16 had mesh removal plus ilioinguinal or iliohypog astric neurectomy. Good to excellent results were achieved in 12 out o f 20 patients (60%). Average followup time was 15.9 +/- 3.1 months. Tw o of 3 patients who had laparoscopic herniorrhaphy had favorable outco mes (67%). Ten of the 16 patients who had mesh removal plus neurectomy reported good to excellent results (62%) compared with 2 of 4 reporti ng the same with mesh excision only (50%). Eleven patients had pain re lief with preoperative nerve block. Of these, 9 had elective neurectom y resulting in good to excellent results in 5 (56%). Conclusions: Reme dial inguinal exploration and mesh removal with or without neurectomy resulted in favorable outcomes in 60% of patients with mesh herniorrha phy chronic inguinodynia (neuralgia). It appears that coincident neure ctomy affords better results than mesh removal alone. Relief with nerv e block did not predict favorable outcomes. Despite the popularity and favorable outcomes of prosthetic mesh repairs, persistent postoperati ve pain still occurs in a small cohort of patients. This may become mo re evident with the rising interest in laparoscopy. Correcting this pr oblem once presented can be a formidable task. Remedial inguinal surge ry with mesh removal and neurectomy will cure selected patients. (J Am Cell Surg 1998;187:514-518. (C) 1998 by the American College of: Surg eons).