The Experts below are selected from a list of 603 Experts worldwide ranked by ideXlab platform
J F M Lange - One of the best experts on this subject based on the ideXlab platform.
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Nerve identifying inguinal hernia repair a surgical anatomical study
World Journal of Surgery, 2007Co-Authors: A R Wijsmuller, J F M Lange, Gertjan Kleinrensink, D Van Geldere, M P Simons, F J P M Huygen, J JeekelAbstract:Background: Pain syndromes of somatic and neuropathic origin are considered to be the main causes of chronic pain after open inguinal hernia repair. Nerve-identification during open hernia repair is suggested to be associated with less postoperative chronic pain. The aim of this study was to define clinically relevant surgical anatomical zones facilitating efficient identification of the three inguinal Nerves during open herniorrhaphy. Method: Through dissection of 18 inguinal areas of embalmed and unembalmed human cadavers, identification zones were developed for the inguinal Nerves (in particular for the genital branch of the genitofemoral Nerve). Results: The iliohypogastric Nerve was identifiable running approximately horizontally and ventrally to the internal oblique muscle perforating the external oblique aponeurosis at a mean of 3.8 cm (range 2.5-5.5 cm) cranially from the external ring. When present, the Ilioinguinal Nerve was identifiable running ventrally and parallel to the spermatic cord, dorsally from the aponeurosis of the external oblique muscle. Identification of the genital branch of the genitofemoral Nerve was more comprehensive. The course of the genital branch is laterocaudal at the level of the internal inguinal ring. Conclusion: Based on the newly defined identification zones, peroperative identification of all inguinal Nerves is possible. Further research is warranted to assess clinical feasibility of these zones and to evaluate the influence of (facultative) division, preservation or omittance of the identification of inguinal Nerves on the incidence of chronic pain.
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Nerve management during open hernia repair
British Journal of Surgery, 2007Co-Authors: A R Wijsmuller, J F M Lange, Gertjan Kleinrensink, J Jeekel, J. L. Bosch, R N Van VeenAbstract:Background. Peroperative identification and subsequent division or preservation of the inguinal Nerves during open hernia repair may influence the incidence of chronic postoperative pain. Methods: A systematic literature review was performed to identify studies investigating the influence of different types of Nerve management. Results: Based on three randomized studies the pooled mean percentage of patients with chronic pain after identification and division of the Ilioinguinal Nerve was similar to that after identification and preservation of the Ilioinguinal Nerve. Two cohort studies suggested that the incidence of chronic pain was significantly lower after identification of all inguinal Nerves compared with no identification of any Nerve. Another cohort study reported a significant difference in the incidence of chronic pain in favour of identification and facultative pragmatic division of the genital branch of the genitofemoral Nerve compared with no identification at all. Conclusion: The Nerves should probably be identified during open hernia repair. Division of and preservation of the Ilioinguinal Nerve show similar results.
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Systematic review Nerve management during open hernia repair
2006Co-Authors: A R Wijsmuller, J F M Lange, Gertjan Kleinrensink, J Jeekel, R. N. Van Veen, J. L. BoschAbstract:Background: Peroperative identification and subsequent division or preservation of the inguinal Nerves during open hernia repair may influence the incidence of chronic postoperative pain. Methods: A systematic literature review was performed to identify studies investigating the influence of different types of Nerve management. Results: Based on three randomized studies the pooled mean percentage of patients with chronic pain after identification and division of the Ilioinguinal Nerve was similar to that after identification and preservation of the Ilioinguinal Nerve. Two cohort studies suggested that the incidence of chronic pain was significantly lower after identification of all inguinal Nerves compared with no identification of any Nerve. Another cohort study reported a significant difference in the incidence of chronic pain in favour of identification and facultative pragmatic division of the genital branch of the genitofemoral Nerve compared with no identification at all. Conclusion: The Nerves should probably be identified during open hernia repair. Division of and preservation of the Ilioinguinal Nerve show similar results
Ka Wai Tam - One of the best experts on this subject based on the ideXlab platform.
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preservation versus division of Ilioinguinal Nerve on open mesh repair of inguinal hernia a meta analysis of randomized controlled trials
World Journal of Surgery, 2012Co-Authors: Wayne Hsu, Ching Shyang Chen, Hung Chia Lee, Hung Hua Liang, Li Jen Kuo, Po Li Wei, Ka Wai TamAbstract:Background Chronic groin pain after inguinal hernia repair, a serious problem, is caused by entrapment of the Ilioinguinal Nerve either by mesh or development of fibrosis. Division of the Ilioinguinal Nerve during hernioplasty has been found to reduce the incidence of chronic groin pain. However, the traditional approach favors preservation of the Ilioinguinal Nerve during open hernia repair.
Ahmed M Moeen - One of the best experts on this subject based on the ideXlab platform.
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topical versus caudal ketamine bupivacaine combination for postoperative analgesia in children undergoing inguinal herniotomy
Saudi Journal of Anaesthesia, 2017Co-Authors: Hala Saad Abdelghaffar, Seham M Moeen, Ahmed M MoeenAbstract:Background: Multiple studies claim that caudal administration of ketamine causes effective postoperative analgesia. The aim of this study was to assess the clinical effectiveness of ketamine after caudal or topical administration in pediatric patients undergoing inguinal herniotomy. Patients and Methods: This randomized, comparative, double-blind study included eighty children (aged 6 months to 6 years) received either 1 ml/kg of 0.25% bupivacaine/ketamine 0.5 mg/kg for caudal analgesia (caudal group) or 0.3 ml/kg of 0.25% bupivacaine/ketamine 0.5 mg/kg sprayed by the surgeon around the spermatic cord and upon the Ilioinguinal Nerve before wound closure for topical analgesia (topical group). The duration of postoperative analgesia, pain scores, rescue analgesic consumption, sedation score, hemodynamic monitoring, and side-effects were evaluated 48 h postoperative. Results: Kaplan–Meier survival analysis of analgesia free time demonstrated a significant advantage of topical ketamine (TK) group over caudal ketamine (CK) group. The duration of postoperative analgesia was longer in TK group than in CK group (28.74 ± 2.88 vs. 21.43 ± 5.01 h, P P th till 48 th h were lower in topical group with comparable analgesic consumption between two groups. In the caudal group, four subjects suffered from retention of urine: Two presented with a residual motor block and two had photophobia. Conclusion: Wound instillation of bupivacaine/ketamine is a simple, noninvasive, and effective technique that could be a safe alternative to CK for postoperative analgesia in children undergoing inguinal hernia repair.
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Topical versus caudal ketamine/bupivacaine combination for postoperative analgesia in children undergoing inguinal herniotomy
Wolters Kluwer Medknow Publications, 2017Co-Authors: Seham M Moeen, Ahmed M Moeen, Hala Saad Abdel-ghaffarAbstract:Background: Multiple studies claim that caudal administration of ketamine causes effective postoperative analgesia. The aim of this study was to assess the clinical effectiveness of ketamine after caudal or topical administration in pediatric patients undergoing inguinal herniotomy. Patients and Methods: This randomized, comparative, double-blind study included eighty children (aged 6 months to 6 years) received either 1 ml/kg of 0.25% bupivacaine/ketamine 0.5 mg/kg for caudal analgesia (caudal group) or 0.3 ml/kg of 0.25% bupivacaine/ketamine 0.5 mg/kg sprayed by the surgeon around the spermatic cord and upon the Ilioinguinal Nerve before wound closure for topical analgesia (topical group). The duration of postoperative analgesia, pain scores, rescue analgesic consumption, sedation score, hemodynamic monitoring, and side-effects were evaluated 48 h postoperative. Results: Kaplan–Meier survival analysis of analgesia free time demonstrated a significant advantage of topical ketamine (TK) group over caudal ketamine (CK) group. The duration of postoperative analgesia was longer in TK group than in CK group (28.74 ± 2.88 vs. 21.43 ± 5.01 h, P < 0.000). Fewer children asked for oral analgesics in the topical group (24 of 36, 66.7%) than in the caudal one (28 of 32, 87.5%; P < 0.01). Postoperative pain scores at the 6th till 48th h were lower in topical group with comparable analgesic consumption between two groups. In the caudal group, four subjects suffered from retention of urine: Two presented with a residual motor block and two had photophobia. Conclusion: Wound instillation of bupivacaine/ketamine is a simple, noninvasive, and effective technique that could be a safe alternative to CK for postoperative analgesia in children undergoing inguinal hernia repair
Robert Wright - One of the best experts on this subject based on the ideXlab platform.
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groin anatomy preoperative pain and compression neuropathy in primary inguinal hernia what really matters
American Journal of Surgery, 2019Co-Authors: Robert Wright, Troy Salisbury, Jordan LandesAbstract:Abstract Introduction Enlargement of the Ilioinguinal Nerve distal to the inguinal ring is common in primary open inguinal herniorrhaphy and is histologically consistent with compression neuropathy. However, the origin of this neuropathy has not been thoroughly studied in primary inguinal hernia. Methods In this prospective study, 143 primary inguinal herniorrhaphies were performed. Prior to surgery, all patients completed a preoperative pain questionnaire from the Carolina Comfort Scale and Visual Analog Scale—evaluating pain with various activities. Pain scores were statistically compared with several different anatomical surgical observations. Results When each variable is individually compared with pain scores, a significant positive correlation exists between Nerve enlargement and increased pain compared to those without enlargement for preoperative “most of the time pain” (P Conclusion Preoperative pain in primary inguinal hernia is correlated with Ilioinguinal Nerve enlargement, which is also correlated with fibrosis of the external oblique fascia at the external ring.
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pain and compression neuropathy in primary inguinal hernia
Hernia, 2017Co-Authors: Robert Wright, Donald E Born, Natasha Dsouza, Larissa Hurd, Rachel Gill, Daniel WrightAbstract:Purpose Enlargement of the Ilioinguinal Nerve at the external inguinal ring is observed in 34% of patients undergoing primary open inguinal herniorrhaphy; in 88% of patients it occurs at the fascial edge where the hernia mushrooms with abdominal pressure. Compression neuropathy occurs near many anatomical Nerve constriction sites and is associated with enlargement of the peripheral Nerve accompanied by sensory changes.
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pain and compression neuropathy in primary inguinal hernia
Hernia, 2017Co-Authors: Robert Wright, Donald E Born, Natasha Dsouza, Larissa Hurd, Rachel Gill, Daniel WrightAbstract:Enlargement of the Ilioinguinal Nerve at the external inguinal ring is observed in 34% of patients undergoing primary open inguinal herniorrhaphy; in 88% of patients it occurs at the fascial edge where the hernia mushrooms with abdominal pressure. Compression neuropathy occurs near many anatomical Nerve constriction sites and is associated with enlargement of the peripheral Nerve accompanied by sensory changes. In this prospective study, Carolina Comfort Scale (CCS) questionnaire data was collected for 35 primary hernia repairs. Each patient underwent primary inguinal herniorrhaphy that included Ilioinguinal neurectomy. All Nerves were sampled proximal to the external inguinal ring. Any Nerves with grossly increased overall diameter to any degree distal to the external ring were additionally sampled in the thickened portions. A neuropathologist performed histologic evaluation of the H&E-stained cross sections. Paired comparison of proximal and distal Nerves revealed a greater overall diameter and greater measured Nerve-specific diameter in distal Nerve segments. Nerves with increased overall diameter were also found to have a statistically significant positive correlation with four of eight pain measures. Additionally, increased Nerve-specific diameter correlates with increased pain on four of eight pain values, but age effect on Nerve diameter blunts this finding. Increased preoperative CCS pain values in primary open inguinal hernia are significantly correlated with gross enlargement of the overall diameter and Nerve-specific diameter of the Ilioinguinal Nerve beyond the external inguinal ring. This is consistent with a compression neuropathy.
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why do inguinal hernia patients have pain histology points to compression neuropathy
American Journal of Surgery, 2017Co-Authors: Robert Wright, Donald E Born, Natasha Dsouza, Larissa Hurd, Rachel Gill, Daniel WrightAbstract:Abstract Purpose The purpose of this study is to describe the known soft tissue neuro-histology factors associated with compression neuropathy in relation to the incidence of preoperative pain in primary inguinal hernia. Enlargement of the Ilioinguinal Nerve occurs in 63% of patients with primary inguinal hernia; compression neuropathy has similar gross features. Methods Patients completed pain questionnaires pertaining to preoperative pain and the quality of pain experienced. During routine inguinal hernia repair, Nerve segments were sampled for histologic evaluation. Results Twenty-two thickened Nerve segments (63% of total) with proximal and distal specimens were resected for examination and comparison. We quantified various histologic indicators including Nerve diameter, fascicle count, myxoid content within the epineurium, perineurium and endoneurium. Increased preoperative patient pain scores correlate with increased Nerve diameter, increased fascicle count and increased myxoid material both within the perineurium and endoneurium. Conclusion These findings support the concept that preoperative hernia pain is associated with compression neuropathy.
Daniel Wright - One of the best experts on this subject based on the ideXlab platform.
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pain and compression neuropathy in primary inguinal hernia
Hernia, 2017Co-Authors: Robert Wright, Donald E Born, Natasha Dsouza, Larissa Hurd, Rachel Gill, Daniel WrightAbstract:Enlargement of the Ilioinguinal Nerve at the external inguinal ring is observed in 34% of patients undergoing primary open inguinal herniorrhaphy; in 88% of patients it occurs at the fascial edge where the hernia mushrooms with abdominal pressure. Compression neuropathy occurs near many anatomical Nerve constriction sites and is associated with enlargement of the peripheral Nerve accompanied by sensory changes. In this prospective study, Carolina Comfort Scale (CCS) questionnaire data was collected for 35 primary hernia repairs. Each patient underwent primary inguinal herniorrhaphy that included Ilioinguinal neurectomy. All Nerves were sampled proximal to the external inguinal ring. Any Nerves with grossly increased overall diameter to any degree distal to the external ring were additionally sampled in the thickened portions. A neuropathologist performed histologic evaluation of the H&E-stained cross sections. Paired comparison of proximal and distal Nerves revealed a greater overall diameter and greater measured Nerve-specific diameter in distal Nerve segments. Nerves with increased overall diameter were also found to have a statistically significant positive correlation with four of eight pain measures. Additionally, increased Nerve-specific diameter correlates with increased pain on four of eight pain values, but age effect on Nerve diameter blunts this finding. Increased preoperative CCS pain values in primary open inguinal hernia are significantly correlated with gross enlargement of the overall diameter and Nerve-specific diameter of the Ilioinguinal Nerve beyond the external inguinal ring. This is consistent with a compression neuropathy.
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pain and compression neuropathy in primary inguinal hernia
Hernia, 2017Co-Authors: Robert Wright, Donald E Born, Natasha Dsouza, Larissa Hurd, Rachel Gill, Daniel WrightAbstract:Purpose Enlargement of the Ilioinguinal Nerve at the external inguinal ring is observed in 34% of patients undergoing primary open inguinal herniorrhaphy; in 88% of patients it occurs at the fascial edge where the hernia mushrooms with abdominal pressure. Compression neuropathy occurs near many anatomical Nerve constriction sites and is associated with enlargement of the peripheral Nerve accompanied by sensory changes.
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why do inguinal hernia patients have pain histology points to compression neuropathy
American Journal of Surgery, 2017Co-Authors: Robert Wright, Donald E Born, Natasha Dsouza, Larissa Hurd, Rachel Gill, Daniel WrightAbstract:Abstract Purpose The purpose of this study is to describe the known soft tissue neuro-histology factors associated with compression neuropathy in relation to the incidence of preoperative pain in primary inguinal hernia. Enlargement of the Ilioinguinal Nerve occurs in 63% of patients with primary inguinal hernia; compression neuropathy has similar gross features. Methods Patients completed pain questionnaires pertaining to preoperative pain and the quality of pain experienced. During routine inguinal hernia repair, Nerve segments were sampled for histologic evaluation. Results Twenty-two thickened Nerve segments (63% of total) with proximal and distal specimens were resected for examination and comparison. We quantified various histologic indicators including Nerve diameter, fascicle count, myxoid content within the epineurium, perineurium and endoneurium. Increased preoperative patient pain scores correlate with increased Nerve diameter, increased fascicle count and increased myxoid material both within the perineurium and endoneurium. Conclusion These findings support the concept that preoperative hernia pain is associated with compression neuropathy.
