Initial experience of minimally invasive mesh explantation for inguinodynia

• DOI: 10.1111/ans.19158
• Publication Date: 2024-07-12T12:59:20Z
• Authors: Jonathan Wiener; Elan Novis; Joel Rabindran; Douglas Fenton‐Lee
• Keywords: Male; Adult; Pain, Postoperative; Hernia, Inguinal; Surgical Mesh; Middle Aged; 03 medical and health sciences; Treatment Outcome; 0302 clinical medicine; Robotic Surgical Procedures; Quality of Life; Humans; Female; Laparoscopy; Chronic Pain; Herniorrhaphy; Device Removal; Retrospective Studies; Aged; Pain Measurement

AbstractBackgroundChronic pain after minimally invasive inguinal hernia repair with mesh can have debilitating effects on quality of life (QOL), limiting daily activities and ability to work. Many medical and surgical options for treatment have been proposed, however there is no consensus on the role of mesh explantation in the management of these patients.MethodsWe performed a retrospective review of all patients who underwent groin mesh removal by robotic or laparoscopic approach from July 2012 to July 2023 at our institution. Patients were interviewed post‐operatively to determine their overall pain scores and QOL was assessed using the Carolinas Comfort Scale (CCS) Questionnaire. Patient characteristics, operative times, pre‐operative imaging techniques and analgesia use was also recorded.ResultsTwenty‐two patients underwent groin mesh removal for chronic pain, including 12 robotic and 10 laparoscopic operations. The mean pre‐operative pain score in all patients was 7.6/10 compared to 4.0/10 post‐operatively. The mean post‐operative CCS score was 24, indicating moderate discomfort. Four patients demonstrated CCS scores <11 indicating no discomfort and no patients demonstrated CCS scores >90, indicating severe debilitating discomfort. The majority of patients had a reduction or total cessation of analgesia intake post‐operatively.ConclusionBoth laparoscopic and robotic mesh explantation for treatment of chronic pain post‐inguinal hernia repair is safe and effective in achieving a reduction in pain and reducing the need for long‐term analgesia.