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MRI and pathology in persistent postherniotomy pain.

Eske Kvanner Aasvang1, Karl-Erik Jensen, Bente Fiirgaard

  • 1Section of Surgical Pathophysiology, Diagnostics Center, Rigshospitalet, Copenhagen University, Copenhagen, Denmark. eskeaasvang@yahoo.dk

Journal of the American College of Surgeons
|May 30, 2009
PubMed
Summary

Magnetic Resonance Imaging (MRI) shows poor agreement between observers for diagnosing persistent postherniotomy pain. MRI findings are not specific enough to guide surgical treatment for this condition.

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Area of Science:

  • Radiology
  • Surgical Outcomes
  • Pain Management

Background:

  • Persistent postherniotomy pain affects 5-10% of patients after groin hernia repair.
  • Magnetic Resonance Imaging (MRI) may help investigate pain mechanisms and guide surgical interventions like mesh removal or neurectomy.
  • No prior studies have assessed interobserver agreement or MRI findings in persistent postherniotomy pain.

Purpose of the Study:

  • To evaluate interobserver agreement for MRI findings in patients with persistent postherniotomy pain.
  • To determine the frequency of specific MRI pathologies in painful groins compared to pain-free groins.
  • To assess the utility of MRI in identifying specific pathologies related to persistent postherniotomy pain.

Main Methods:

  • 32 patients with chronic postherniotomy pain and 6 pain-free controls underwent MRI.
  • Two blinded observers assessed groins using a predefined list of pathologies and landmarks.
  • Interobserver agreement was calculated using kappa coefficients; pathology frequencies were compared between groups.

Main Results:

  • Interobserver agreement was generally poor (kappa 0.24-0.55), except for "contrast enhancement in groin" (kappa 0.69).
  • "Contrast enhancement in groin," "edema," and "spermatic cord caliber increased" were more frequent in painful groins than unoperated groins.
  • No specific MRI pathology was identified in all painful groins, and no significant difference was found between painful and pain-free operated groins.

Conclusions:

  • Interobserver agreement for MRI findings in persistent postherniotomy pain is low.
  • MRI-assessed pathologies are unspecific for persistent postherniotomy pain.
  • Further research on interobserver agreement is needed before MRI can guide surgical treatment decisions.