Multidisciplinary approach to chronic postoperative inguinal pain

Abstract

Background: Chronic postoperative inguinal pain represents a complication that alters the quality of
life after inguinal hernioplasty. Its incidence is variable with reports of up to 16%. 
Objective: To describe the treatment and results in patients with chronic inguinal pain after an inguinal hernioplasty with mesh.
Material and methods: Descriptive, observational and retrospective study. The postoperative chronic inguinal pain was defined as the presence of inguinal pain due to nerve damage or involvement of the somatosensory tissue system that persists for more than 6 months after the initial surgery. The medical records of patients in the postoperative period of conventional and laparoscopic inguinal hernioplasty in the period 2010-2018 were reviewed. The EuraHS Quality of life score pre and post multidisciplinary therapeutic approach was used to evaluate changes in pain and restriction of physical activity. The results were analyzed and compared.
Results: 8 patients with severe chronic postoperative inguinal pain were identified. 100% were evaluated by the pain management service and required 3 or more drugs for pain management. Subsequently, they required block guided by computed tomography due to persistence of symptoms. 3 (50%) surgical examinations were performed with removal of prosthetic material and 2 triple neurectomies. A statistically significant decrease (p <0.05) was observed in pain at rest, pain during activity and pain experienced in the last week.
Conclusion: The multidisciplinary and step up approach would allow selecting the patients who will benefit from the surgical treatment.