Chronic pain after TEP inguinal hernia repair, does MRI reveal a cause?
J P J Burgmans1, C E H Voorbrood2, T Van Dalen2
1Department of Surgery/Hernia Clinic, Diakonessenhuis Utrecht/Zeist, Room: Secretariaat Heelkunde, Professor Lorentzlaan 76, 3707 HL, Zeist, The Netherlands. iburgmans@diakhuis.nl.
Purpose:
Persistent pain is a known side effect after TEP inguinal repair disabling 2-5% of patients. A standardized diagnostic work-up so far is not available. MRI is a diagnostic tool in the work-up of inguinal hernias. In the present study the yield of MRI in evaluating chronic pain after TEP hernia repair is addressed.
Methods:
In our database patients receiving an MRI scan for groin pain lasting more than 3 months after TEP inguinal hernia repair were identified. A checklist with potential pathologic findings was filled out for each groin by two blinded observers. Findings in painful, pain-free and unoperated groins were compared and statistical analysis done based upon their relative incidences. Cohen's kappa coefficients were calculated to determine interobserver agreement.
Results:
Imaging studies of 53 patients revealed information regarding 106 groins. Fifty-five groins were painful after the initial operation, 12 were pain-free postoperatively and 39 groins were not operated. None of the predefined disorders was observed statistically more often in the patients with painful groins. Only fibrosis appeared more prevalent in patients with chronic pain (P = 0.11). Interobserver agreement was excellent for identifying the mesh (κ = 0.88) and observing bulging or a hernia (κ = 0.74) and was substantial for detecting fibrosis (κ = 0.63). In 40% of the patients, MRI showed a correct mesh position and observed nothing else than minor fibrosis. A wait and see policy resolved complaints in the majority of the patients. In 15 % of the patients, MRI revealed treatable findings explanatory for persisting groin pain.
Conclusion:
For patients with post-TEP hernia groin pain, MRI is useful to confirm a correct flat mesh position and to identify possible not operation-related causes of groin pain. It is of little help to identify a specific cause of groin repair-related pain.
Insights
Magnetic resonance imaging (MRI) can confirm mesh placement after trans-epidermal plug (TEP) hernia repair but offers limited insight into specific causes of chronic groin pain. It helps identify non-surgical pain origins in some cases.
Area of Science:
- Abdominal Surgery
- Medical Imaging
- Pain Management
Background:
- Persistent pain affects 2-5% of patients post-trans-epidermal plug (TEP) inguinal hernia repair.
- A standardized diagnostic approach for this chronic groin pain is lacking.
- Magnetic resonance imaging (MRI) is a valuable tool for evaluating inguinal hernias.
Purpose of the Study:
- To assess the diagnostic yield of MRI in evaluating chronic groin pain after TEP inguinal hernia repair.
- To determine the utility of MRI in identifying specific causes of post-TEP groin pain.
Main Methods:
- Patients with groin pain >3 months post-TEP repair undergoing MRI were identified.
- Two blinded observers used a checklist for potential pathologic findings.
- Findings in painful, pain-free, and unoperated groins were compared; interobserver agreement was assessed using Cohen's kappa coefficients.
Main Results:
- MRI revealed correct mesh position in 40% of patients with only minor fibrosis.
- No predefined disorders were statistically more prevalent in painful groins; fibrosis was borderline significant (P=0.11).
- MRI identified treatable findings in 15% of patients, explaining persistent groin pain.
Conclusions:
- MRI is useful for confirming correct mesh placement and identifying non-surgical causes of post-TEP groin pain.
- MRI has limited utility in pinpointing specific causes of groin repair-related pain.
- A 'wait and see' approach resolved symptoms in most patients where MRI showed only minor fibrosis.
More Related Videos
07:20Intraoperative Detection of Subtle Endometriosis: A Novel Paradigm for Detection and Treatment of Pelvic Pain Associated with the Loss of Peritoneal Integrity
Published on: December 21, 2012
14:56An Experimental Paradigm for the Prediction of Post-Operative Pain PPOP
Published on: January 27, 2010
