The patients in the GroinPain trial will be more homegeneous, hopefully resulting inhigher success rates. Moreover, a potential disadvantage <strong>of</strong> a classic triple procedure isneuroma formation in previously unaffected nerves with a possible onset <strong>of</strong> deafferentation<strong>pain</strong>.This study also evaluates secondary endpoints such as quality <strong>of</strong> life and impact onoccupational disability. Any improvement in quality <strong>of</strong> life will further underscore theneed for standardized treatment protocols. We are currently under the impression thatan operative neurectomy may serve as the backbone <strong>of</strong> such treatment regimes.However, the present randomized study may find that nerve blocks may also serve asan important tool in the treatment <strong>of</strong> this growing patient population.REFERENCES1 Cunningham J, Temple WJ, Mitchell P, Preshaw RM, Hagen NA. Cooperative hernia study. Pain in thepostrepair patient. Ann Surg 1996; 224: 598-6022 Bay-Nielsen M, Perkins FM, Kehlet H . Pain and functional impairment 1 year after <strong>inguinal</strong>herniorrhaphy: a nationwide questionnaire study. Ann Surg 2001; 233: 1-73 Loos MJ, Roumen RM, Scheltinga MR. Chronic sequelae <strong>of</strong> common elective groin hernia repair.Hernia 2007; 11: 169-1734.4 Nienhuijs SW, Boelens OB, Strobbe LJ. Pain after anterior mesh hernia repair. J Am Coll Surg 2005;200: 885-8895 Loos MJ, Roumen RM, Scheltinga MR. Classifying post-herniorrhaphy <strong>pain</strong> <strong>syndromes</strong> followingelective <strong>inguinal</strong> hernia repair. World J Surg 2007; 31: 1760-17656 Johansson A, Bennett GJ. Effect <strong>of</strong> local methylprednisolone on <strong>pain</strong> in a nerve injury model. Apilot study. Reg Anesth 1997; 22: 59-657 Cohen SP, Foster A. Pulsed radi<strong>of</strong>requency as a treatment for groin <strong>pain</strong> and orchialgia. Urology2003; 61: 6458 Aasvang EK, Kehlet H. The effect <strong>of</strong> mesh removal and selective neurectomy on persistent postherniotomy<strong>pain</strong>. Ann Surg 2009; 249: 327-3349 Amid PK. Causes, prevention, and surgical treatment <strong>of</strong> postherniorrhaphy neuropathic inguinodynia:triple neurectomy with proximal end implantation. Hernia 200410 Ducic I, West J, Maxted W. Management <strong>of</strong> <strong>chronic</strong> postoperative groin <strong>pain</strong>. Ann Plast Surg 2008;60: 294-298; 8: 343-34911 Giger U, Wente MN, Buchler MW, Krahenbuhl S, Lerut J, Krahenbuhl L. Endoscopic retroperitonealneurectomy for <strong>chronic</strong> <strong>pain</strong> after groin surgery. Br J Surg 2009; 96: 1076-108112 Loos MJ, Scheltinga MR, Roumen RM. Tailored neurectomy for treatment <strong>of</strong> postherniorrhaphy<strong>inguinal</strong> neuralgia. Surgery 2010; 147: 275-28113 Vuilleumier H, Hubner M, Demartines N. Neuropathy after herniorrhaphy: indication for surgicaltreatment and outcome. World J Surg 2009; 33: 841-84514 McCarthy M, Jr., Chang CH, Pickard AS, Giobbie-Hurder A, Price DD, Jonasson O, Gibbs J, FitzgibbonsR, Neumayer L . Visual analog scales for assessing surgical <strong>pain</strong>. J Am Coll Surg 2005; 201: 245-25215 Van der Kloot WA, Oostendorp RA, van der MJ, van den HJ. [The Dutch version <strong>of</strong> the McGill <strong>pain</strong>questionnaire: a reliable <strong>pain</strong> questionnaire]. Ned Tijdschr Geneeskd 1995; 139: 669-67316 Ware JE, Jr., Gandek B. Overview <strong>of</strong> the SF-36 Health Survey and the International Quality <strong>of</strong> LifeAssessment (IQOLA) Project. J Clin Epidemiol 1998; 51: 903-91217 Bennett M. The LANSS Pain Scale: the Leeds assessment <strong>of</strong> neuropathic symptoms and signs. Pain2001; 92: 147-15718 Kehlet H, Jensen TS, Woolf CJ. Persistent postsurgical <strong>pain</strong>: risk factors and prevention. Lancet 2006;367: 1618-162519 Hamer<strong>of</strong>f SR, Crago BR, Blitt CD, Womble J, Kanel J. Comparison <strong>of</strong> bupivacaine, etidocaine, andsaline for trigger-point therapy. Anesth Analg 1981; 60: 752-75520 Curatolo M, Bogduk N. Pharmacologic <strong>pain</strong> treatment <strong>of</strong> musculoskeletal disorders: currentperspectives and future prospects. Clin J Pain 2001; 17: 25-32104 Chapter 7Randomized controlled trial <strong>of</strong> neurectomy versus injection with lidocain, corticosteroids... 105
CHAPTER 8<strong>Surgical</strong> <strong>management</strong> <strong>of</strong><strong>inguinal</strong> neuralgia after a lowtransverse Pfannenstiel incisionLoos MJA, Scheltinga MRM, Roumen RMHAnn Surg 2008; 248: 880-885106 Chapter 8<strong>Surgical</strong> <strong>management</strong> <strong>of</strong> <strong>inguinal</strong> neuralgia after a low transverse Pfannenstiel incision 107
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