Pain and compression neuropathy in primary inguinal hernia
R Wright1, D E Born2, N D'Souza3
1Cascade Hernia Institute, 208 17th Ave SE Suite 201, Puyallup, WA, 98372, USA. bob@robertwrightmd.com.
Hernia : the Journal of Hernias and Abdominal Wall Surgery
|August 19, 2017
Summary
Enlarged ilioinguinal nerves are common in patients with primary open inguinal hernias. This nerve enlargement, particularly beyond the external inguinal ring, correlates with increased pain, suggesting compression neuropathy.
Area of Science:
- Surgical anatomy
- Neuropathology
- Hernia repair outcomes
Background:
- Enlargement of the ilioinguinal nerve at the external inguinal ring occurs in 34% of primary open inguinal herniorrhaphy patients.
- Nerve enlargement, often at the fascial edge due to hernia pressure, is linked to compression neuropathy and sensory changes.
Purpose of the Study:
- To investigate the correlation between ilioinguinal nerve diameter and pain in primary open inguinal hernia repair.
- To determine if nerve enlargement beyond the external inguinal ring is associated with preoperative pain.
Main Methods:
- Prospective study of 35 primary inguinal hernia repairs with ilioinguinal neurectomy.
- Histologic evaluation of proximal and distal ilioinguinal nerve segments by a neuropathologist.
- Correlation analysis between nerve diameter (overall and nerve-specific) and pain measures using the Carolina Comfort Scale (CCS).
Main Results:
- Distal ilioinguinal nerve segments showed significantly greater overall and nerve-specific diameters compared to proximal segments.
- Increased overall nerve diameter positively correlated with four of eight pain measures.
- Increased nerve-specific diameter correlated with increased pain on four of eight measures, though age effects were noted.
Conclusions:
- Preoperative pain in primary open inguinal hernia is significantly correlated with enlarged ilioinguinal nerve diameter distal to the external inguinal ring.
- Findings support the hypothesis of compression neuropathy as a cause of pain in these patients.
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