The emerging role of MRI neurography in the diagnosis of chronic inguinal pain.
Chronic pain
Inguinal hernia
Inguinal hernia repair
MRN
VAS score
Journal
Langenbeck's archives of surgery
ISSN: 1435-2451
Titre abrégé: Langenbecks Arch Surg
Pays: Germany
ID NLM: 9808285
Informations de publication
Date de publication:
18 Aug 2023
18 Aug 2023
Historique:
received:
06
12
2022
accepted:
08
08
2023
medline:
21
8
2023
pubmed:
18
8
2023
entrez:
18
8
2023
Statut:
epublish
Résumé
Chronic pain is a frequent and notable complication after inguinal hernia repair, it has been extensively studied, but its management and diagnosis are still difficult. The cause of chronic pain following inguinal hernia surgery is usually multifactorial. This case series highlights the utility of MRI neurography (MRN) in evaluating the damage to inguinal nerves after a hernia repair, with surgical confirmation of the preoperative imaging findings. A retrospective review was performed on patients who underwent inguinal mesh removal and triple denervation of the groin. Inclusion criteria included MRI neurography. All patients underwent surgical exploration of the inguinal canal for partial or complete mesh removal and triple denervation of the groin by the same senior surgeon. A total of nine patients who underwent triple denervation were included in this case series. MRN was then performed on 100% of patients. The postoperative mean VAS score adjusted for all patients was 1.6 (SD p), resulting in a 7.5 score difference compared to the preoperative VAS score (p). Since chronic groin pain can be a severely debilitating condition, diagnosis, and treatment become imperative. MRN can detect direct and indirect signs of neuropathy even in the absence of a detectable compressive cause aids in management and diagnosis by finding the precise site of injury, and grading nerve injury to aid pre-operative assessment for the nerve surgeon. Thus, it is a valuable diagnostic tool to help with the diagnosis of nerve injuries in the setting of post-inguinal hernia groin pain.
Identifiants
pubmed: 37594580
doi: 10.1007/s00423-023-03050-9
pii: 10.1007/s00423-023-03050-9
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
319Informations de copyright
© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
Références
Andresen K, Rosenberg J (2018) Management of chronic pain after hernia repair. J Pain Res 11:675–681. https://doi.org/10.2147/JPR.S127820
doi: 10.2147/JPR.S127820
pubmed: 29670394
pmcid: 5896652
Marcus DA (2005) Chronic pain: a primary care guide to practical management, vol 1. Humana Press, Inc, Totowa, NJ, pp 333–318
doi: 10.1385/159259882X
Treede RD, Rief W, Barke A, Aziz Q, Bennett MI, Benoliel R, Cohen M, Evers S, Finnerup NB, First MB, Giamberardino MA, Kaasa S, Kosek E, Lavand'homme P, Nicholas M, Perrot S, Scholz J, Schug S, Smith BH et al (2015) A classification of chronic pain for ICD-11. Pain 156(6):1003–1007. https://doi.org/10.1097/j.pain.0000000000000160
doi: 10.1097/j.pain.0000000000000160
pubmed: 25844555
pmcid: 4450869
Alfieri S, Amid PK, Campanelli G et al (2011) International guidelines for prevention and management of post-operative chronic pain following inguinal hernia surgery. Hernia 15:239–249. https://doi.org/10.1007/s10029-011-0798-9
doi: 10.1007/s10029-011-0798-9
pubmed: 21365287
Morrison Z, Kashyap S, Nirujogi VL ( 2022) Adult inguinal hernia. StatPearls Publishing, Treasure Island (FL). https://www.ncbi.nlm.nih.gov/books/NBK537241/?report=classic
Nikkolo C, Lepner U (2016) Chronic pain after open inguinal hernia repair. Postgrad Med 128(1):69–75. https://doi.org/10.1080/00325481.2016.1121090
doi: 10.1080/00325481.2016.1121090
pubmed: 26567717
Aasvang E, Kehlet H (2005) Surgical management of chronic pain after inguinal hernia repair. Br J Surg 92(7):795–801. https://doi.org/10.1002/bjs.5103
doi: 10.1002/bjs.5103
pubmed: 15962258
HerniaSurge Group (2018) International guidelines for groin hernia management. Hernia 22(1):1–165. https://doi.org/10.1007/s10029-017-1668-x
doi: 10.1007/s10029-017-1668-x
Poobalan AS, Bruce J, King PM, Chambers WA, Krukowski ZH, Smith WC (2001) Chronic pain and quality of life following open inguinal hernia repair. Br J Surg 88(8):1122–1126. https://doi.org/10.1046/j.0007-1323.2001.01828.x
doi: 10.1046/j.0007-1323.2001.01828.x
pubmed: 11488800
Song JW, Wolf JS Jr, McGillicuddy JE, Bhangoo S, Yang LJ (2011) Laparoscopic triple neurectomy for intractable groin pain: technical report of 3 cases. Neurosurgery. 68(2 Suppl Operative):339–346. https://doi.org/10.1227/NEU.0b013e3182114480
doi: 10.1227/NEU.0b013e3182114480
pubmed: 21336213
Amid PK (2002) A 1-stage surgical treatment for postherniorrhaphy neuropathic pain: triple neurectomy and proximal end implantation without mobilization of the cord. Arch Surg 137(1):100–104. https://doi.org/10.1001/archsurg.137.1.100
doi: 10.1001/archsurg.137.1.100
pubmed: 11772226
Lee P, Dorsi M, Belzberg A, Chhabra A (2011) Magnetic resonance neurography-surgical correlation of neurologic thoracic outlet syndrome. Microsurgery. 31(8):662–665. https://doi.org/10.1002/micr.20935
doi: 10.1002/micr.20935
pubmed: 21919052
Hakeem A, Shanmugam V (2011) Current trends in the diagnosis and management of post-herniorraphy chronic groin pain. World J Gastrointest Surg 3(6):73–81. https://doi.org/10.4240/wjgs.v3.i6.73
doi: 10.4240/wjgs.v3.i6.73
pubmed: 21765970
pmcid: 3135872
Madura JA, Madura JA 2nd, Copper CM, Worth RM (2005) Inguinal neurectomy for inguinal nerve entrapment: an experience with 100 patients. Am J Surg 189(3):283–287. https://doi.org/10.1016/j.amjsurg.2004.11.015
doi: 10.1016/j.amjsurg.2004.11.015
pubmed: 15792751
Amid PK (2004) Causes, prevention, and surgical treatment of postherniorrhaphy neuropathic inguinodynia: triple neurectomy with proximal end implantation. Hernia 8:343–349. https://doi.org/10.1007/s10029-004-0247-0
doi: 10.1007/s10029-004-0247-0
pubmed: 15290609
Amid PK (2004) Radiologic images of meshoma: a new phenomenon causing chronic pain after prosthetic repair of abdominal wall hernias. Arch Surg 139(12):1297–1298. https://doi.org/10.1001/archsurg.139.12.1297
doi: 10.1001/archsurg.139.12.1297
pubmed: 15611452
Seddon HJ (1943) Three types of nerve injury. Brain 66(4):237–288. https://doi.org/10.1093/brain/66.4.237
Robinson L (2000) Traumatic injury to peripheral nerves. American Association of Electrodiagnostic Medicine, Seattle, pp 1–3 https://www.aanem.org/mxonline/resources/downloads/Monograph/28_Traumatic%20Injury%20to%20Peripheral%20Nerves.pdf . Accessed July 31, 2022
Drake RL, Vogl W, Mitchell AWM (2005) Gray’s anatomy for students. Churchhill Livingstone (Elsevier Inc.), Philadelphia, PA, pp 253–254
Ariyasinghe C, Gajera J. Iliohypogastric nerve. Reference article, Radiopaedia.org. https://doi.org/10.53347/rID-38666 . Accessed 30 Jul 2022
Delaney H, Bencardino J, Rosenberg ZS (2014) Magnetic resonance neurography of the pelvis and lumbosacral plexus. Neuroimaging Clin N Am 24(1):127–150. https://doi.org/10.1016/j.nic.2013.03.026
doi: 10.1016/j.nic.2013.03.026
pubmed: 24210317
Gupton M, Varacallo M. Anatomy, abdomen and pelvis, genitofemoral nerve. StatPearls Publishing, Treasure Island (FL). https://www.ncbi.nlm.nih.gov/books/NBK430733/
Dessouky R, Xi Y, Scott KM et al (2018) Magnetic resonance neurography in chronic lumbosacral and pelvic pain: diagnostic and management impact-institutional audit. World Neurosurg 114:e77–e113. https://doi.org/10.1016/j.wneu.2018.02.072
doi: 10.1016/j.wneu.2018.02.072
pubmed: 29581014
Aggarwal A, Chhabra A (2022) Magnetic resonance neurography: is it so complicated that it needs a touch of genius? Eur Radiol 32:3912–3914. https://doi.org/10.1007/s00330-021-08525-1
doi: 10.1007/s00330-021-08525-1
pubmed: 35103831
Chhabra A, Belzberg A, Rosson G et al (2015) Impact of high resolution 3 Tesla MR neurography (MRN) on diagnostic thinking and therapeutic patient management. Eur Radiol 26(5):1235–1244. https://doi.org/10.1007/s00330-015-3958-y
doi: 10.1007/s00330-015-3958-y
pubmed: 26396110
Tagliafico A, Succio G, Serafini G, Martinoli C (2012) Diagnostic accuracy of MRI in adults with suspect brachial plexus lesions: a multicentre retrospective study with surgical findings and clinical follow-up as reference standard. Eur J Radiol 81(10):2666–2672. https://doi.org/10.1016/j.ejrad.2011.10.007
doi: 10.1016/j.ejrad.2011.10.007
pubmed: 22071340
Chhabra A, Thawait GK, Soldatos T, Thakkar RS, Del Grande F, Chalian M, Carrino JA (2013) High-resolution 3T MR neurography of the brachial plexus and its branches, with emphasis on 3D imaging. AJNR Am J Neuroradiol 34(3):486–497. https://doi.org/10.3174/ajnr.A3287
doi: 10.3174/ajnr.A3287
pubmed: 22976233
pmcid: 7964914