The study found that a significant fraction of post-herniorrhaphy pain in patients may be the result of preexisting nerve damage rather than operative trauma. Previously, surgeons have always considered the pain associated with the hernia to be a visceral pinch or muscular pain and have not considered the possibility of nerve damage, said Robin Wright, MD, a private practice surgeon at Meridian Surgery Center in Pullayup, Wash.
Dr. Wright’s study included 100 consecutive cases of primary inguinal hernia repair. He performed all procedures using the Lichtenstein technique, but removed the ilioinguinal nerve and occasionally the iliohypogastric and genitofemoral nerves.
Dr. Wright removed 84 nerves in the 100 cases performed on 90 patients. If he felt that a resected nerve was damaged, he sent it to a pathologist for examination. The pathologist confirmed that 34 of the 35 nerves had nerve damage defined as neuritis. Overall, 11 percent of the potentially affected nerves were characterized as having neuritis, and in all cases, the surgeon was able to accurately diagnose the condition intraoperatively.
While the presence of neuritis was associated with patients’ anecdotal pain in chart records, no standardized pain measurement tools were used, making it difficult to correlate preoperative pain with the presence of neuritis.
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