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The Effect of Mesh Removal and Selective Neurectomy on Persistent Postherniotomy Pain

Aasvang, Eske K. MD*†; Kehlet, Henrik MD, PhD*

doi: 10.1097/SLA.0b013e31818eec49
Original Articles

Summary Background Data and Objective: Persistent pain affects everyday activities in 5% to 8% of patients after groin hernia repair. Because previous reports on the effect of neurectomy and/or mesh removal suffer from methodological problems we performed a detailed prospective trial of the effect of neurectomy and mesh removal on persistent postherniotomy pain.

Methods: Twenty-one patients with postherniotomy pain >1 year, pain-related impairment of daily activities and a well-defined maximum pain localization where included. Inserted mesh was removed and a selective neurectomy was done in case of macroscopic nerve injury. The primary end point was changes in pain-related impairment of everyday activities assessed by the validated activities assessment scale before surgery and 6 months postoperatively. Quantitative sensory testing was used to evaluate sensory functions pre and postoperatively.

Results: All patients completed the 6-month follow-up. There was a significant improvement in the activities assessment scale score for the whole group (preoperative vs. 6 months = 27 vs. 13 points, P = 0.004), despite 3 patients worsening. Quantitative sensory testing showed a significant postoperative increase in pressure pain detection threshold (P = 0.045) and cutaneous detection and pain thresholds (mechanical and warmth) (P < 0.03).

Conclusions: Selective neurectomy and mesh removal may improve pain-related activity impairment in patients with persistent postherniotomy pain. Detailed neurophysiologic assessment is recommended to identify patients who may or may not benefit from reoperation and to allocate patients to specific surgical and/or medical intervention.

Selective neurectomy and mesh removal were performed in 21 patients with severe persistent postherniotomy pain. Significant improvement of everyday activities and neurophysiologic function was seen at 6-month follow-up, despite 3 patients worsening. Detailed neurophysiologic assessment is recommended to identify patients who may or may not benefit from reoperation.

From the *Section of Surgical Pathophysiology, Rigshospitalet, Copenhagen University, Copenhagen, Denmark; and †Ambulatory Surgical Clinic, Hørsholm Hospital, Hørsholm, Denmark.

This study was supported by a grant from the Lundbeck foundation.

The authors declare no conflicts of interest.

Reprints: Eske Kvanner Aasvang, MD, Section of Surgical Pathophysiology, 4074, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark. E-mail: eskeaasvang@yahoo.dk.

© 2009 Lippincott Williams & Wilkins, Inc.