The Experts below are selected from a list of 315 Experts worldwide ranked by ideXlab platform
David C Chen - One of the best experts on this subject based on the ideXlab platform.
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intra operative vascular injury and control during laparoscopic and robotic mesh explantation for chronic post herniorrhaphy Inguinal Pain cpip
Surgical technology international, 2021Co-Authors: Stephanie W Lau, Ian T Macqueen, David C ChenAbstract:INTRODUCTION Chronic postherniorrhaphy Inguinal Pain (CPIP) is common following Inguinal hernia repair. As even primary minimally-invasive Inguinal hernia repairs carry a risk of significant intra-operative bleeding, it is unsurprising that reoperative groin exploration and mesh explantation for chronic post-Inguinal herniorrhaphy Pain confers an even higher risk of arteriotomy or venotomy due to a distorted anatomy and the presence of adhesions. In this report, we present a single institution's experience with the management of intra-operative vascular injury encountered during minimally invasive groin exploration and mesh explantation for CPIP. MATERIALS AND METHODS We performed a retrospective consecutive case series study at a single academic center of patients with CPIP who underwent minimally invasive groin exploration and mesh removal during which an iatrogenic arteriotomy or venotomy occurred from September 2015 to September 2020. Descriptive statistics were collected for age, laterality of hernia repair, mean follow-up time, surgical approach (robotic vs. laparoscopic), type of intra-operative vascular injury, vascular control technique, and post-operative complications. RESULTS Of 196 minimally invasive groin exploration and mesh removal cases, 46 were performed with robotic assistance and 150 were performed using traditional laparoscopy. The overall incidence of intra-operative vascular injury was 43 (22%). Fifteen of 46 (32%) robotic groin exploration and mesh removal cases and 28 of 150 (19%) laparoscopic cases involved vascular control. Three of 15 (20%) robotic cases and 23 of 28 (82%) laparoscopic cases involved a hybrid open Inguinal approach to address anterior pathology (neurectomy, anterior mesh removal, hernia repair) or facilitate exposure for vascular repair. The most common site of injury was the inferior epigastric vessels. Other sites included the iliac vein, iliac artery, corona mortis, and accessory obturator vessels. Vascular control techniques included ligation with an energy device or suture, primary suture repair of injured vessel, or bovine pericardium patch angioplasty. All were managed without intra-operative vascular surgery intervention except for one case with extensive calcification that required endarterectomy and angioplasty to improve patency. No cases required conversion to midline laparotomy. Ninety three percent of the cases with large vessel bleeding during laparoscopic-assisted procedures were repaired via an open groin incision, whereas all cases of large vessel bleeding during robotic-assisted procedures were repaired robotically. None of the patients required transfusion. Postoperative complications occurred in 3 patients (7%), 2 (5%) developed hematoma formation requiring surgical evacuation, and 1 (2%) developed ipsilateral iliofemoral deep vein thrombosis (DVT) and underwent peripheral angiography and thrombolysis. CONCLUSIONS Although minimally invasive groin exploration and mesh explantation for CPIP is technically challenging, it is a safe and effective operation when performed at experienced centers. Iatrogenic vascular injury should be anticipated but can be effectively controlled laparoscopically, robotically, or via a hybrid open Inguinal incision without conversion to a midline laparotomy and with low post-operative complication rates.
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approach to the patient with chronic groin Pain
Surgical Clinics of North America, 2018Co-Authors: David C ChenAbstract:Chronic postoperative Inguinal Pain has become a primary outcome parameter after elective Inguinal hernia repair with significant consequences affecting patient productivity, employment, and quality of life. A systematic and thorough preoperative evaluation is important to identify the etiologies and types of Pain. Owing to the complex nature of chronic Pain, a multimodal and multidisciplinary treatment approach is recommended. Patients with chronic Pain refractory to conservative measures may be considered for surgical intervention. Triple neurectomy remains the most definitive and accepted remedial operation performed and provides effective relief in the majority of patients.
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Inguinal neuroanatomy implications for prevention of chronic postInguinal hernia Pain
International Journal of Abdominal Wall and Hernia Surgery, 2018Co-Authors: Danielle S Graham, Ian T Macqueen, David C ChenAbstract:Inguinal hernia repairs represent one of the most common general surgery operations worldwide. Advances in the understanding of groin anatomy, operative technique, and prosthetics have improved the efficacy of these repairs with overall low recurrence rates and favorable outcomes. Chronic postherniorrhaphy Inguinal Pain has arguably become the most important and most frequent complication of Inguinal hernia repair, with significant impact on patients' quality of life. Neuropathic inguinodynia may be caused by direct nerve injury, manipulation, entrapment, scarring, and interaction with mesh. Development of chronic postInguinal hernia repair Pain is independent of the method of hernia repair as all Inguinal hernia repair techniques may potentially cause injury. Understanding the neuroanatomy of the Inguinal canal and the potential mechanisms for injury leads to lower rates of nerve injury and chronic Pain and helps to guide prevention and treatment of inguinodynia. In this article, the neuroanatomy of the anterior Inguinal canal and the prevention of nerve injury are addressed.
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laparoscopic approaches to chronic postoperative Inguinal Pain
2018Co-Authors: David Nguyen, David C ChenAbstract:Chronic postoperative Inguinal Pain refractory to medical management is a challenging condition with significant costs and impact on a patient’s quality of life and limited options for remediation and Pain relief. Laparoscopic approaches to Inguinal neurectomy are a valuable, highly effective adjunct in dealing with neuropathic postoperative Inguinal Pain. Safe and effective mesh removal may be facilitated by laparoscopic or hybrid techniques that allow for greater visualization and dissection of mesh from the posterior wall. Orchialgia may be improved with laparoscopic paravasal neurectomy. There is no one size fits all, as each approach needs to be tailored to the patient’s initial repair, Pain symptoms and distribution, physical exam, imaging, and shared decision-making. A solid understanding of the anterior and posterior anatomy, mechanisms of injury, and laparoscopic and open routes to access pathology provides a broad range of options to tailor treatment and improve outcomes.
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chronic postoperative Inguinal Pain cpip
2018Co-Authors: W Reinpold, David C ChenAbstract:It is well established that almost every surgical intervention may lead to chronic Pain. According to published trials with systematic data collection, the highest chronic Pain rates are reported after leg amputation, thoracotomy, and breast surgery with 60%, 50%, and 30%, respectively [1].
Parviz K Amid - One of the best experts on this subject based on the ideXlab platform.
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neurophysiological and clinical effects of laparoscopic retroperitoneal triple neurectomy in patients with refractory postherniorrhaphy neuropathic inguinodynia
Pain Practice, 2017Co-Authors: Martin F Bjurstrom, Parviz K Amid, Andrea L Nicol, Christine H Lee, Francis Michael Ferrante, David C ChenAbstract:BACKGROUND: Chronic postherniorrhaphy Inguinal Pain (CPIP) is a complex, major health problem. In the absence of recurrence or meshoma, laparoscopic retroperitoneal triple neurectomy (LRTN) has emerged as an effective surgical treatment of CPIP.METHODS: This prospective pilot study evaluated the neurophysiological and clinical effects of LRTN. Ten consecutive adult CPIP patients with unilateral predominantly neuropathic inguinodynia underwent three comprehensive quantitative sensory testing (QST) assessments (preoperative, immediate postoperative, and late postoperative). Pain severity, health-related function, and sleep quality were assessed over the course of a 6-month follow-up period.RESULTS: QST revealed marked increases in mechanical, pressure, thermal, and Pain thresholds in the areas with maximum Pain prior to LRTN surgery for the immediate (P < 0.01; mean 160.9 minutes, range 103 to 255 minutes after extubation) and late postoperative (P < 0.05; mean 27.9 days, range 14 to 78 days after surgery) assessments compared to baseline. Wind-up phenomena were eliminated postoperatively. LRTN provided robust group-level improvements of all clinical measures. No preoperative QST variables were found to be predictive of surgical outcomes. The positive change in heat Pain threshold (preoperative compared to late postoperative) showed significant positive correlations with improvements of Pain scores and function.CONCLUSIONS: LRTN may produce immediate, profound, and consistent positive effects across multiple mechanical, pressure, and thermal QST variables, and marked improvements of clinical outcomes in selected CPIP patients. These data contribute to the understanding of mechanisms involved in the success of LRTN. Large, high-powered studies are warranted to determine whether preoperative or repeated longitudinal QST may guide patient selection and predict effectiveness of LRTN. (Less)
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quantitative validation of sensory mapping in persistent postherniorrhaphy Inguinal Pain patients undergoing triple neurectomy
Hernia, 2017Co-Authors: Martin F Bjurstrom, Parviz K Amid, R Alvarez, Andrea L Nicol, Richard G Olmstead, David C ChenAbstract:Purpose Neurectomy of the Inguinal nerves may be considered for selected refractory cases of chronic postherniorrhaphy Inguinal Pain (CPIP). There is to date a paucity of easily applicable clinical tools to identify neuropathic Pain and examine the neurosensory effects of remedial surgery. The present quantitative sensory testing (QST) pilot study evaluates a sensory mapping technique.
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quantitative validation of sensory mapping in persistent postherniorrhaphy Inguinal Pain patients undergoing triple neurectomy
Hernia, 2017Co-Authors: Parviz K Amid, Martin F Bjurstrom, R Alvarez, Andrea L Nicol, Richard G Olmstead, David C ChenAbstract:Neurectomy of the Inguinal nerves may be considered for selected refractory cases of chronic postherniorrhaphy Inguinal Pain (CPIP). There is to date a paucity of easily applicable clinical tools to identify neuropathic Pain and examine the neurosensory effects of remedial surgery. The present quantitative sensory testing (QST) pilot study evaluates a sensory mapping technique. Longitudinal (preoperative, immediate postoperative, and late postoperative) dermatomal sensory mapping and a comprehensive QST protocol were conducted in CPIP patients with unilateral, predominantly neuropathic inguinodynia presenting for triple neurectomy (n = 13). QST was conducted in four areas on the affected, Painful side and in one contralateral comparison site. QST variables were compared according to sensory mapping outcomes: (o)/normal sensation, (+)/Pain, and (−)/numbness. Diagnostic ability of the sensory mapping outcomes to detect QST-assessed allodynia or hypoesthesia was estimated through calculation of specificity and sensitivity values. Preoperatively, patients exhibited mechanical hypoesthesia and allodynia and pressure allodynia and hyperalgesia in Painful areas mapped (+) (p < .05); sensory mapping outcome (+) demonstrated high ability to detect mechanical allodynia [sensitivity 0.74 (95% CI 0.61–0.86), specificity 0.94 (0.84–1.00)] and pressure allodynia [sensitivity 0.96 (0.89–1.00), specificity 1.00 (1.00–1.00)], but not thermal allodynia. Postoperatively, mapped areas of numbness (−) were associated with mechanical and thermal hypoesthesia (p < .05); (−) showed high sensitivity and specificity to detect mechanical and cold hypoesthesia. Sensory mapping provides an accurate clinical neuropathic assessment with strong correlation to QST findings of preoperative mechanical and pressure allodynia, and postoperative mechanical and thermal hypoesthesia in CPIP patients undergoing neurectomy.
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open triple neurectomy
2016Co-Authors: Ian T Macqueen, David C Chen, Parviz K AmidAbstract:Postherniorrhaphy chronic Pain is a significant cause of morbidity following Inguinal hernia repair. Patients with inguinodynia refractory to conservative treatment may be considered for operative remediation. Triple neurectomy remains the most definitive operative modality for addressing neuropathic causes of Inguinal Pain. A thorough understanding of groin neuroanatomy is crucial, and successful outcomes are dependent upon choosing patients with discrete neuroanatomic problems amenable to surgical correction. Open triple neurectomy involves segmental resection of the ilioInguinal nerve (IIN), the genital branch of the genitofemoral nerve (GFN), and the iliohypogastric nerve (IHN). Variations on this operation involve resecting the main branch of the GFN for patients whose original repair entered the preperitoneal space and resecting the paravasal nerves for patients with orchialgia in addition to inguinodynia. Triple neurectomy is successful in greater than 90 % of carefully selected patients with postherniorrhaphy chronic Pain.
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an international consensus algorithm for management of chronic postoperative Inguinal Pain
Hernia, 2015Co-Authors: Johan F M Lange, David C Chen, A R Wijsmuller, Rutger J Ploeg, J P E N Pierie, R Kaufmann, Parviz K AmidAbstract:Purpose Tension-free mesh repair of Inguinal hernia has led to uniformly low recurrence rates. Morbidity associated with this operation is mainly related to chronic Pain. No consensus guidelines exist for the management of this condition. The goal of this study is to design an expert-based algorithm for diagnostic and therapeutic management of chronic Inguinal postoperative Pain (CPIP).
Anuj Bhatia - One of the best experts on this subject based on the ideXlab platform.
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a scoping review of perineural steroids for the treatment of chronic postoperative Inguinal Pain
Hernia, 2016Co-Authors: J S Khan, A Rai, Sundara R Rajan, T D Jackson, Anuj BhatiaAbstract:Purpose To review the literature on the efficacy and safety of perineural steroid injections around the ilioInguinal, iliohypogastric, and genitofemoral nerves for chronic postoperative Inguinal Pain (CPIP).
Martin F Bjurstrom - One of the best experts on this subject based on the ideXlab platform.
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neurophysiological and clinical effects of laparoscopic retroperitoneal triple neurectomy in patients with refractory postherniorrhaphy neuropathic inguinodynia
Pain Practice, 2017Co-Authors: Martin F Bjurstrom, Parviz K Amid, Andrea L Nicol, Christine H Lee, Francis Michael Ferrante, David C ChenAbstract:BACKGROUND: Chronic postherniorrhaphy Inguinal Pain (CPIP) is a complex, major health problem. In the absence of recurrence or meshoma, laparoscopic retroperitoneal triple neurectomy (LRTN) has emerged as an effective surgical treatment of CPIP.METHODS: This prospective pilot study evaluated the neurophysiological and clinical effects of LRTN. Ten consecutive adult CPIP patients with unilateral predominantly neuropathic inguinodynia underwent three comprehensive quantitative sensory testing (QST) assessments (preoperative, immediate postoperative, and late postoperative). Pain severity, health-related function, and sleep quality were assessed over the course of a 6-month follow-up period.RESULTS: QST revealed marked increases in mechanical, pressure, thermal, and Pain thresholds in the areas with maximum Pain prior to LRTN surgery for the immediate (P < 0.01; mean 160.9 minutes, range 103 to 255 minutes after extubation) and late postoperative (P < 0.05; mean 27.9 days, range 14 to 78 days after surgery) assessments compared to baseline. Wind-up phenomena were eliminated postoperatively. LRTN provided robust group-level improvements of all clinical measures. No preoperative QST variables were found to be predictive of surgical outcomes. The positive change in heat Pain threshold (preoperative compared to late postoperative) showed significant positive correlations with improvements of Pain scores and function.CONCLUSIONS: LRTN may produce immediate, profound, and consistent positive effects across multiple mechanical, pressure, and thermal QST variables, and marked improvements of clinical outcomes in selected CPIP patients. These data contribute to the understanding of mechanisms involved in the success of LRTN. Large, high-powered studies are warranted to determine whether preoperative or repeated longitudinal QST may guide patient selection and predict effectiveness of LRTN. (Less)
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quantitative validation of sensory mapping in persistent postherniorrhaphy Inguinal Pain patients undergoing triple neurectomy
Hernia, 2017Co-Authors: Martin F Bjurstrom, Parviz K Amid, R Alvarez, Andrea L Nicol, Richard G Olmstead, David C ChenAbstract:Purpose Neurectomy of the Inguinal nerves may be considered for selected refractory cases of chronic postherniorrhaphy Inguinal Pain (CPIP). There is to date a paucity of easily applicable clinical tools to identify neuropathic Pain and examine the neurosensory effects of remedial surgery. The present quantitative sensory testing (QST) pilot study evaluates a sensory mapping technique.
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quantitative validation of sensory mapping in persistent postherniorrhaphy Inguinal Pain patients undergoing triple neurectomy
Hernia, 2017Co-Authors: Parviz K Amid, Martin F Bjurstrom, R Alvarez, Andrea L Nicol, Richard G Olmstead, David C ChenAbstract:Neurectomy of the Inguinal nerves may be considered for selected refractory cases of chronic postherniorrhaphy Inguinal Pain (CPIP). There is to date a paucity of easily applicable clinical tools to identify neuropathic Pain and examine the neurosensory effects of remedial surgery. The present quantitative sensory testing (QST) pilot study evaluates a sensory mapping technique. Longitudinal (preoperative, immediate postoperative, and late postoperative) dermatomal sensory mapping and a comprehensive QST protocol were conducted in CPIP patients with unilateral, predominantly neuropathic inguinodynia presenting for triple neurectomy (n = 13). QST was conducted in four areas on the affected, Painful side and in one contralateral comparison site. QST variables were compared according to sensory mapping outcomes: (o)/normal sensation, (+)/Pain, and (−)/numbness. Diagnostic ability of the sensory mapping outcomes to detect QST-assessed allodynia or hypoesthesia was estimated through calculation of specificity and sensitivity values. Preoperatively, patients exhibited mechanical hypoesthesia and allodynia and pressure allodynia and hyperalgesia in Painful areas mapped (+) (p < .05); sensory mapping outcome (+) demonstrated high ability to detect mechanical allodynia [sensitivity 0.74 (95% CI 0.61–0.86), specificity 0.94 (0.84–1.00)] and pressure allodynia [sensitivity 0.96 (0.89–1.00), specificity 1.00 (1.00–1.00)], but not thermal allodynia. Postoperatively, mapped areas of numbness (−) were associated with mechanical and thermal hypoesthesia (p < .05); (−) showed high sensitivity and specificity to detect mechanical and cold hypoesthesia. Sensory mapping provides an accurate clinical neuropathic assessment with strong correlation to QST findings of preoperative mechanical and pressure allodynia, and postoperative mechanical and thermal hypoesthesia in CPIP patients undergoing neurectomy.
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Pain control following Inguinal herniorrhaphy current perspectives
Journal of Pain Research, 2014Co-Authors: Martin F Bjurstrom, Parviz K Amid, Andrea L Nicol, David C ChenAbstract:Inguinal hernia repair is one of the most common surgeries performed worldwide. With the success of modern hernia repair techniques, recurrence rates have significantly declined, with a lower incidence than the development of chronic postherniorrhaphy Inguinal Pain (CPIP). The avoidance of CPIP is arguably the most important clinical outcome and has the greatest impact on patient satisfaction, health care utilization, societal cost, and quality of life. The etiology of CPIP is multifactorial, with overlapping neuropathic and nociceptive components contributing to this complex syndrome. Treatment is often challenging, and no definitive treatment algorithm exists. Multidisciplinary management of this complex problem improves outcomes, as treatment must be individualized. Current medical, pharmacologic, interventional, and surgical management strategies are reviewed.
Johan F M Lange - One of the best experts on this subject based on the ideXlab platform.
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uniformity of chronic Pain assessment after Inguinal hernia repair a critical review of the literature
European Surgical Research, 2017Co-Authors: Marijke Molegraaf, Johan F M Lange, A R WijsmullerAbstract:Background: Chronic postoperative Inguinal Pain (CPIP) is the most common long-term complication of Inguinal hernia repair. As such procedures are routinely performed, CPIP can be considered a significant burden to global health care. Therefore, adequate preventative measures relevant to surgical practice are investigated. However, as no gold standard research approach is currently available, study and outcome measures differ between studies. The current review aims to provide a qualitative analysis of the literature to seek out if outcomes of CPIP are valid and comparable, facilitating recommendations on the best approach to preventing CPIP. Methods: A systematic review of recent studies investigating CPIP was performed, comprising studies published in 2007-2015. Study designs were analyzed regarding the CPIP definitions applied, the use of validated instruments, the availability of a baseline score, and the existence of a minimal follow-up of 12 months. Results: Eighty eligible studies were included. In 48 studies, 22 different definitions of CPIP were identified, of which the definition provided by the International Association for the Study of Pain was applied most often. Of the studies included, 53 (66%) used 33 different validated instruments to quantify CPIP. There were 32 studies (40%) that assessed both Pain intensity (PI) and quality of life (QOL) with validated tools, 41% and 4% had a validated assessment of only PI or QOL, respectively, and 15% lacked a validated assessment. The visual analog scale and the Short Form 36 (SF36) were most commonly used for measuring PI (73%) and QOL (19%). Assessment of CPIP was unclear in 15% of the studies included. A baseline score was assessed in 45% of the studies, and 75% had a follow-up of at least 12 months. Conclusion: The current literature addressing CPIP after Inguinal hernia repair has a variable degree of quality and lacks uniformity in outcome measures. Proper comparison of the study results to provide conclusive recommendations for preventive measures against CPIP therefore remains difficult. These findings reaffirm the need for a uniform and validated assessment with uniform reporting of outcomes to improve the burden that CPIP poses to a significant surgical patient population.
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the role of surgical expertise with regard to chronic postoperative Inguinal Pain cpip after lichtenstein correction of Inguinal hernia a systematic review
Hernia, 2016Co-Authors: Johan F M Lange, V M Meyer, D A Voropai, E Keus, A R Wijsmuller, Rutger J Ploeg, J P E N PierieAbstract:Objective The aim of this study was to evaluate whether a relation exists between surgical expertise and incidence of chronic postoperative Inguinal Pain (CPIP) after Inguinal hernia repair using the Lichtenstein procedure .
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an international consensus algorithm for management of chronic postoperative Inguinal Pain
Hernia, 2015Co-Authors: Johan F M Lange, David C Chen, A R Wijsmuller, Rutger J Ploeg, J P E N Pierie, R Kaufmann, Parviz K AmidAbstract:Purpose Tension-free mesh repair of Inguinal hernia has led to uniformly low recurrence rates. Morbidity associated with this operation is mainly related to chronic Pain. No consensus guidelines exist for the management of this condition. The goal of this study is to design an expert-based algorithm for diagnostic and therapeutic management of chronic Inguinal postoperative Pain (CPIP).
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an international consensus algorithm for management of chronic postoperative Inguinal Pain
Hernia, 2015Co-Authors: Johan F M Lange, David C Chen, A R Wijsmuller, Rutger J Ploeg, J P E N Pierie, R Kaufmann, Parviz K AmidAbstract:Tension-free mesh repair of Inguinal hernia has led to uniformly low recurrence rates. Morbidity associated with this operation is mainly related to chronic Pain. No consensus guidelines exist for the management of this condition. The goal of this study is to design an expert-based algorithm for diagnostic and therapeutic management of chronic Inguinal postoperative Pain (CPIP). A group of surgeons considered experts on Inguinal hernia surgery was solicited to develop the algorithm. Consensus regarding each step of an algorithm proposed by the authors was sought by means of the Delphi method leading to a revised expert-based algorithm. With the input of 28 international experts, an algorithm for a stepwise approach for management of CPIP was created. 26 participants accepted the final algorithm as a consensus model. One participant could not agree with the final concept. One expert did not respond during the final phase. There is a need for guidelines with regard to management of CPIP. This algorithm can serve as a guide with regard to the diagnosis, management, and treatment of these patients and improve clinical outcomes. If an expectative phase of a few months has passed without any amelioration of CPIP, a multidisciplinary approach is indicated and a Pain management team should be consulted. Pharmacologic, behavioral, and interventional modalities including nerve blocks are essential. If conservative measures fail and surgery is considered, triple neurectomy, correction for recurrence with or without neurectomy, and meshoma removal if indicated should be performed. Surgeons less experienced with remedial operations for CPIP should not hesitate to refer their patients to dedicated hernia surgeons.