INTRODUCTION (SEE SURVEY BELOW)

While many patients have some prolonged post-operative discomfort after any surgery, which may last for several months before resolving, approximately 3-5% of such patients may develop chronic or persistent pain in the region of a surgical incision. This can also occur and be especially bothersome after hernia repair. Post-operative pain, after hernia surgery particularly, can develop from a variety of causes. Often, only with an examination by a surgeon or Hernia Specialist, can the exact cause be identified. Even then, the exact cause may not be identifiable.

There are many causes for this persistent, post-operative hernia-area pain (also called 'Inguinodynia') including, but certainly not limited to:

• Nerve damage (directly at the time of surgery)
• Nerve entrapment in scar tissue, mesh or sutures
• Post-operative benign nerve tumors (Neuromas)
• Scar Tissue itself or tissue damage
• Misplaced Mesh (if used)
• Contracted, scarified and hardened mesh plugs ("Meshomas")
• Infection (usually noted early post-op.)
• Recurrent (or Persistent) Hernia.
• Constriction or Narrowing of the Internal Inguinal Ring around the spermatic cord
• Periostitis-Inflammation of the outer membrane of the bone (pubic) due to the presence of permanent suture material inadvertently placed into this layer resulting in chroinic inflammation and pain
• Pain from Unrelated Causes, associated with neither the prior inguinal hernia nor its operative repair (i.e., Non-hernia musculoskeletal, Intra-abdominal, Intra-pelvic, Neurologic, Genito-urinary, Infectious or Vascular origin etc.)

The exact cause of any individual patient's pain cannot be determined of course, nor can specific treatment be recommended without an examination. The diagnosis is a clinical one, and imaging studies such as X-rays, MRI or CT scans are often normal in these circumstances. Imaging studies in cases of persistent post-operative pain are however of value in excluding intra-abdominal or other unrelated causes for pain that is not associated with the prior hernia surgery.

Many Patients are referred to us from other Surgeons and Pain-Management physicians with persistent post-operative pain following hernia surgery. In addition to a comprehensive medical and surgical history, a complete physical examination is performed. We also will review the "operative report" (dictated at the time of the initial surgery by the surgeon) in hopes of finding clues as to the possible cause(s) of the persistent pain. For most patients, we initially recommend conservative, non-operative treatment measures, especially in cases where the pain is not too severe. These treatment modalities may include:

• Physical Therapy
• Pain Management Specialist Consultation
• Anti-inflammatory Pain Medication

Often, but only in severe, debilitating or persistent cases of pain lasting more than one (1) year, repeat operation is offered in an attempt to improve the status of the patients. We attempt to identify the cause of the pain at surgery and if possible correct the problem based on our intra-operative findings. Examples of surgical steps utilized in this remedial procedure may include:

• Identifying nerve fibers that may be slightly encased in scar tissue, a possible source for pain. When found and if possible, they are surgically released.
• If the nerves are inextricably caught in scar, as is more often the case, the nerves are severed or cut.
• Recurrent hernias may also be present. These too are searched for and repaired if found.
• Conglomerated and bunched up mesh (meshomas) is removed.
• Folded or pleted mesh is unfolded and flattened or if necessary excised.
• Benign nerve tumors from nerve injury or post-operative scarring (called "neuromas") are searched for and if found excised along with its adjacent nerve.
• Excessively knotted permanent suture material, especially in the region of the pubic bone, is also removed.
• The spermatic cord structures (blood vessels, vas deferens) are mobilized and freed from surrounding scar tissue.

At this time we will often also reconstruct the inguinal canal in a Tension-Free fashion to meet our specifications for operative hernia repair. But again, no accurate diagnosis nor treatment plan can be specifically made without an initial examination.

Reasonable expectations achieved by repeat operation in patients referred to us with severe or debilitating post-operative "POST HERNIORRHAPHY PAIN SYNDROME" who have failed to improve with the above conservative measures are as follows:

• 50-60%- Completely or nearly completely Pain-Free (Patients no longer disabled, and require no regular pain medication)
• 20-25%- Some Residual Pain but Improved (Patient essentially normally functioning, some medication occasionally used)
• 12-15%- No Change after Repeat Surgery (Patients feel about the same as before surgery..continues to use analgesics medication)
• 2-3%- Pain may be worse
  

We are trying to evaluate all of the potential causes and factors leading to this complication. We will then use this data to formulate a TREATMENT PLAN that hopefully can be effective long term. We hope to identify an effective, non-surgical management protocol for treating patients with this problem which will be beneficial.

SURVEY

KINDLY COMPLETE THE FOLLOWING FORM FOR OUR RESEARCH!!
Please Complete Form
then
Click on "SEND" Below (Do Not Hit Return)

NAME (optional)

AGE

WEIGHT(POUNDS)

GENDER ? Choose MALE FEMALE

EMAIL Address
@

• 
  
  WHAT TYPE OF HERNIA DID YOU HAVE REPAIRED?
  Choose INGUINAL (ONE SIDE) INGUINAL (BOTH SIDES) RECURRENT INGUINAL FEMORAL UMBILICAL INCISIONAL SPIGELIAN
• 
  
  HOW LONG AGO WAS YOUR SURGERY?
  Choose LESS THAN 6 MONTHS AGO 6-12 MONTHS AGO 1-2 YEARS AGO 2-4 YEARS AGO 4-6 YEARS AGO OVER 6 YEARS
• 
  
  WERE YOU EVER PAIN FREE AFTER SURGERY
  Choose YES NO
• 
  
  AT WHAT TIME AFTER SURGERY DID YOUR CURRENT PAIN LEVEL DEVELOP?
  Choose IMMEDIATELY AFTER SURGERY LESS THAN 1 MONTHS LATER 1-3 MONTHS LATER 3-6 MONTHS LATER 6-9 MONTHS LATER 9-12 MONTHS LATER OVER 1 YEAR AFTER SURGERY
• 
  
  BRIEFLY DESCRIBE HOW/WHEN CURRENT PAIN DEVELOPED.
  
• 
  
  WHAT METHOD OF REPAIR WAS USED?
  Choose LAPAROSCOPIC OPEN, MUSCLE SUTURE, NO MESH (ie CANADIAN) OPEN, MUSCLE SUTURE, WITH MESH ADDED MESH TENSION FREE (PLUG, PATCH, KUGEL) DON'T KNOW!!!
• 
  
  IF USED, WHAT MESH PRODUCT WAS USED?
  Choose NO MESH, SUTURE TECHNIQUE FLAT SHEET OVER SUTURES PLUG AND PATCH ETHICON PROLENE SYSTEM KUGEL PATCH GORTEX OR PTFE MARLEX DON'T KNOW!!!
• 
  
  WHAT ANETHESIA WAS USED?
  Choose LOCAL GENERAL (ASLEEP) SPINAL
• 
  
  IF EMPLOYED, WHAT TYPE OF WORK ENVIORNMENT?
  Choose DESK/CLERICAL/SENDENTARY PROFEESSIONAL(IN/OUT OF OFFICE) SALES RETAIL BUSINESS LIGHT LABORER HEAVY LABORER
• 
  
  HAS THE PAIN LIMITED YOUR WORK ABILITY?
  Choose YES NO
• 
  
  IF YES, DESCRIBE THE LIMITATIONS AT WORK.
  All Information will be Confidential
• 
  
  ARE YOU SELF-EMPLOYED?
  Choose YES NO
• 
  
  WEEKLY WORK HOURS?
  Choose FULL TIME(35 HOURS OR MORE) 20-34 lESS THAN 20
• 
  
  YEARS AT CURRENT JOB?
  Choose 10 OR MORE 5-10 YEARS 1-5 YEARS LESS THAN 1
• 
  
  PLEASE DESCRIBE YOUR WORK ACTIVITY BRIEFLY.
  All Information will be Confidential
• 
  
  PLEASE DESCRIBE YOUR NON-WORK ACTIVITY LEVEL NOW, AND LIMITATIONS
  All Information will be Confidential
• 
  
  PLEASE DESCRIBE ANY TREATMENTS FOR THIS PAIN YOU HAVE RECEIVED! HAS IT HELPED?
  Include Medication, Physical Therapy/Exercises (Describe if Possible), Injections or Repeat Surgery
  All Information will be Confidential