Chronic Pain After Hernia Operations: Chronic Pain Syndrome

Hernia operations are “commonly” pain-free for patients: especially after inginual hernias, the patients may be discharged with a simple analgesic. And is it always so? Are serious pain suffers possible after the operation? Are months lasting chronic pains during post-operational term possible? Is the operation is technically inadequate performed, even if less, chronic pain suffer is possible. 

The 2 main causes of pain after any surgery are tension in the surgery area and the harm of tissues. Beside this, considering hernia, a tensioned repair does not only mean pain for the patient, but also constitute a risk for re-incur of the hernia. At a tension-free repair, deeming that the surgeon has operated careful, are though that pains possible? Yes, it is possible. It is necessary to see the 3 important sense nerves (ileohypogastric, ileoinginual, genitofemoral nerves) and not to harm these. Except this, the contact of the mesh at its place with these nerves may also cause pain.

We can differ the pains after hernia as the early term and late term pains. The more careful work of the surgeon and/or the utilization of the laparoscopic method results in no or very less pain. Such pain is relieved is short time by simple analgesics. 

With the continue and not relief of acute pains, chronic pains incur. The most frequent reason for chronic pain is the harming of the mentioned nerves. The pains due to the harm of these nerves may mostly be recovered with medical treatment. But only a minority of the patients need a “surgical" re-examination of the inginual region. These patients feel relief when the nerves in the region are cut. The ratio of patients with chronic pains which need a surgical intervention is in general very low. We had patients, who consulted us due to chronic pains after operation at other clinics, who we examined and treated, but there were no patients, who we operated in our clinic and needed an operation again.

Beside this, it is known that chronic pains have patient dependent reasons. Those with genetic aptitude, melancholic personality and some women are more sensitive against these pains. If there should be such a risk, the patient should definitely operated with the closed method. There are experimental studies in order to determine which patients have a lower pain threshold and to estimate which will suffer pain.


Orevention of Chronic Pain

There is a significant difference open and closed surgery regarding this. These 3 nerves, with which the surgeon is confronted during the open surgery, are not seen at closed surgery and by this the risk of an injury is much less. The closed surgery is much more secure and comfortable than the open surgery regarding the early and late term pains.

Also the type of the used meshes show differences in respect of pain. It is known that the light meshes, developed in the last years, are better in aspects of pain and comfort. These meshes are thinner, softer than the classical meshes and perforated. It is also advantageous due to that the tissue reaction in the wound area is less. 

Also how the mesh is fixed at its place is an important parameter regarding the chronic pains. If the meshes are between two stabile layers, they may be not fixed. If it should be deemed that one of the front or back walls is weak, it definitely must be fixed to the stabile layer. The fixing method may be by seaming, screwing or tissue gluing. And during the open surgery, as these 3 nerves are seen, it must be assured that these are not harmed. The mesh and the seams of the mesh may not squeeze the nerves. ProGrip, a self-adhesive mesh, is deemed to provide the best result regarding the pain.


Treatment of Chronic Pain

When the patient should have chronic pains, primarily medical treatment is initiated. Analgesics, anti-inflammatory medications, application of long term effective anaesthetic and anti-inflammatory medical injection on the surgery region, physical treatment and TENS treatment (delivery of electric current via the skin) is performed. A majority of the patients respond positive on medical treatments. If the complaints should continue for 8-12 months due to medical treatment, it is necessary to examine the surgery region surgically. By this operation it is necessary to relief the squeezed nerves, to remove the mesh and the fixing materials on the mesh like the mesh seams, screw etc.

The chronic pain syndrome after hernia operations have to be treated by experienced centres or surgeons related to hernia surgery.


THE HERNIA CENTRE
We know that our work is human focussed. We believe that the human is in the centre of all our professional activities and that our target is somehow preventive medicine.
THE HERNIA CENTRE
We know that our work is human focussed. We believe that the human is in the centre of all our professional activities and that our target is somehow preventive medicine.
CONTACT US
+90 541 411 90 00
+90 541 411 90 00
+90 212 296 33 96
bilgi@drkocer.com
Vital Fulya Plaza
Teşvikiye Mah. Hakkı Yeten Cad. No:23 Kat:8 Med-Ofis Fulya / Şişli / İSTANBUL
Vital Fulya Plaza
Teşvikiye Mah. Hakkı Yeten Cad.
No:23 Kat:8 Med-Ofis
Fulya / Şişli / İSTANBUL