Surgical management of chronic inguinal pain syndromes - Liespijn

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on chronic pain. Presence of chronic pain was the dependent variable whereas age,follow-up duration, priority of CD, number of Pfannenstiel incisions, numbness, and scarlength were used as independent variables. The multivariate model was constructedby backward stepwise selection with entry testing based on significance of scorestatistics. CD priority was assessed in a multivariate analysis with CD patients only. Thelimit of statistical significance was set at p=0.05 (two-sided). Analysis was performedusing the Statistical Package for the Social Sciences (SPSS), Windows version 12.0.1RESULTSFigure 1 Schematic drawing in questionnaire that women used for pain localisation with corresponding results.(n=205, missing data in 18 patients). Pain distribution showed in percentages: at the right end of the scar, left end, entirescar, middle of the scar and diffusely in the lower abdomen. 30 patients reported pain at both lateral ends of the scar.Mean incision length, cm (SD= standard deviation) = 13.5 (3.4).QuestionnaireA total of 872 CD’s and 95 AH’s using a Pfannenstiel approach was performed during thetwo year time period. A patient flow chart is depicted in Figure 2. There were 866 post-Pfannenstiel patients who were eligible for this study that received a questionnaire.Eventually, 690 patients returned the questionnaire (response rate 690/866, 80%).Demographic and clinical details of both responders as well as non-responders arelisted in table 1. Except for priority of CD, these two groups were comparable. A CD wasperformed in more than 90% of the women, and an average CD patient was approximately15 years younger compared to an abdominal hysterectomy patient (35 vs. 50yrs, p
significantly and independently predicted chronic pain, whereas age, follow-up and scarlength did not (table 3). In subgroup multivariate analysis, emergency CD remained asignificant factor (OR, 1.56; 95% CI, 1.01-2.40).Questionnaire by mailOutpatient department967 patients with Pfannenstiel incision (872 CD/ 95 AH*)Patients eligible forquestionnaire(n= 866)Response rate: 80%(n=690)Eligible (n=61)History, physicalexamination(n=32)Excluded (n=101):- Deceased (n=6)- Unobtainable address (n=28)- Repeat CD in study period (n=5)- Repeat CD in ‘05-‘06 (n= 15)- Previous abdominal surgery (n= 27)- Midline incision (n= 13)- LAVH** (n=7)Inclusion criterium:Pain intensity: moderate or severe(by VRS-score)Reasons not to participate (n=29):- Recent pain reduction (n=8)- No current tel. no/ address (n=10)- Did not show up (n=5)- Work obligations (n=2)- Currently in advanced pregnancy(n=2)- No interest (n=1)- Alternative treatment (n=1)Figure 2 Flow chart of in-/ excluded patients following a Pfannenstiel incision.*CD = Cesarean Delivery, AH = Abdominal Hysterectomy, **LAVH = Laparoscopic Assisted Vaginal Hysterectomy.Questionnaire (Total n=866) Outpatient department (Total n=61)Responders Non-responders Participators Non-participators(n=690) (n=176) p -value (n=32) (n=29) p-valueMedian age - Yrs [range] 35 [21-77] 24 [21-54] 0.120 34 [27-53] 35 [22-52] 0.800CD/ AH (%)* 643/ 47 (93/ 7) 167/9 (95/5) 0.414 31/1 (97/ 3) 26/ 3 (90/10) 0.255Median follow up - months [range] 26 [14-38] 26 [14-38] 0.731 21 [14-35] 26 [15-38] 0.251Priority CD - elective/ emergency (%) 206/ 437 (32/ 68) 40/127 (24/76) 0.043 10/ 21 (32/ 68) 5/21 (19/81) 0.283Pfannenstiel incisions, noN = 2 (%) 133 (19) 24 (14) 0.478 7 (22) 9 (31) 0.716N > 2 (%) 48 (7) 4 (2) 4 (13) 3 (10)Previous laparoscopic surgery (%) 44 (6) 5 (3) 0.070 2 (6) 6 (21) 0.095Table 1 Characteristics of included patients (n=866) and of those eligible for additional follow up at the outpatient department based on high pain scores (VRS = moderate or severe, n=61).*CD = Cesarean Delivery, AH = Abdominal Hysterectomy.38 Chapter 3The Pfannenstiel approach as a source of chronic pain 39
Page 1 and 2: Surgical managementof chronic ingui
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Page 5 and 6: CHAPTER 1Introduction, aims and out
Page 7 and 8: pathway for the cremasteric reflex.
Page 9 and 10: aims at classifying postherniorrhap
Page 11 and 12: ABSTRACTBackgroundThe aim of this s
Page 13 and 14: The study population consisted main
Page 15 and 16: evaluate if preservation or electiv
Page 17 and 18: CHAPTER 3The Pfannenstiel approacha
Page 19: INTRODUCTIONThe Pfannenstiel incisi
Page 23 and 24: Outpatient assessmentAll patients w
Page 25 and 26: 6 Did you ever visit a physician be
Page 27 and 28: CHAPTER 4Evaluating postherniorrhap
Page 29 and 30: INTRODUCTIONThe introduction of mes
Page 31 and 32: VAS*Values no pain mild moderate se
Page 33 and 34: CHAPTER 5Classifying postherniorrha
Page 35 and 36: INTRODUCTIONChronic pain following
Page 37 and 38: not attained in the remaining ten p
Page 39 and 40: damage, dysfunction of periurethral
Page 41 and 42: CHAPTER 6Tailored neurectomy for tr
Page 43 and 44: INTRODUCTIONWorldwide, many patient
Page 45 and 46: Patients with chronic postherniorrh
Page 47 and 48: operative exploration for a patient
Page 49 and 50: CHAPTER 7Randomized controlled tria
Page 51 and 52: INTRODUCTIONHernia recurrence rates
Page 53 and 54: at the outpatient department as wel
Page 55 and 56: CHAPTER 8Surgical management ofingu
Page 57 and 58: INTRODUCTIONWorldwide millions of l
Page 59 and 60: ‘diagnostic’ nerve block. A one
Page 61 and 62: DISCUSSIONIn the present study a ne
Page 63 and 64: CHAPTER 9Occupational disability du
Page 65 and 66: INTRODUCTIONIn the Netherlands, app
Page 67 and 68: period, a 25% reduction on their in
Page 69 and 70: 17 Madura JA, Madura JA 2nd, Copper
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SUMMARIZING DISCUSSION1. Prevalence
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Results of our study are in concert
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and possible treatment effect. Idea
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CHAPTER 11Nederlandse samenvatting1
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patiënten beschreef hij drie versc
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CHAPTER 12List of publications158 C
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CHAPTER 13Dankwoord162 Chapter 13Da
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CHAPTER 14Curriculum Vitae166 Chapt
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