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Abdulkareem Aldoseri

diagnosis of the involved nerve. Magnetic resonance investigators had, that previous mesh repair did not
neurography was helpful in few cases of this series pain predispose patients to neuropathic pain.
related to neuropraxia, which may last for upto 6 months In addition, we suggest the following measures:
postoperatively and is usually self-limiting and does not Resecting the genital nerve from the same anterior
require surgical intervention. Surgery is required, however, approach to avoid a second-stage operation through the
for per neural fibrosis; nerve entrapment by suture, staple, flank and the possibility of an associated lumbar incisional
or prosthetic device; and neuroma formation as a result of hernia.
axonotmesis, neurotmesis, or complete nerve transection. Implanting the ligated proximal ends of the ilioinguinal
Central and peripheral communication, and frequent and iliohypogastric nerves within the fibers of the internal
multiple nerve involvement can make it extremely difficult, oblique muscle, and allowing proximal cut ends of the genital
if not impossible, to discern which nerve is involved. nerve to retract into the internal ring. This step prevents the
Therefore, surgical treatment of post herniorrhaphy cut ends of the nerves from adhering (via scarification) to
neuralgia should not be limited to a grossly involved nerve, the inguinal ligament and/or external oblique aponeurosis,
but should address all 3 nerves. Furthermore, the triggering which subjects the nerve to traction on walking or moving
or aggravation of the neuropathic pain complex by walking the hip joint and once again sets the stage for postoperative
or hyperextension of the hip and its alleviation by neuralgia.
recumbency and flexion of the thigh suggests that traction Resecting and submitting any tissue fibers resembling a
of the involved nerve due to its adherence to the aponeurotic nerve as well as grossly evident nerve trunks for histologic
tissue of the groin plays a major role in postherniorrhaphy verification to ensure that the resected specimens are neural
pain syndrome. tissues. With exploration and experience, intraoperative
The surgical treatment of postherniorrhaphy neuralgia frozen section may not be necessary, although it can be
should include the insertion of the proximal cut ends under helpful.
the internal oblique muscle fibers to avoid recurrent neuralgia
triggered by adherence of the cut ends of the resected nerves CONCLUSION
to the aponeurotic elements of the groin. Surgical treatment Still there is no enough data to support superiority of laparo-
for periosteal reaction or osteitis pubis consists of removing scopic mesh repair over conventional open mesh repair
suture materials, staples, bulky suture knots, and bulk- regarding postinguinal hernia surgery pain. But it is superior
forming or wadded mesh material from the inguinal region. regarding wound infection and early return to work.
Injection of 80 mg of methylprednisolone acetate under direct
vision during the operative procedure may also be helpful. REFERENCES
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