Surgical management of chronic inguinal pain syndromes - Liespijn

period, a 25% reduction on their income is applied, leaving €25.000 (75% of €34000). Thestate will take over from this time period and compensate the beneficiary. Over a 10-yearperiod the average total costs will approximate €29.000 per year.Yearly, 2% of the postherniorrhaphy hernia repairs will result in severe pain. In theNetherlands, some 440 inguinal hernia repair patients (2% of 22.000 inguinal herniarepairs) will eventually develop a chronic pain syndrome. Most of these patients willsuffer from neuropathic pain that is treatable by a neurectomy. The questionnaire thatPatients with chronicpostherniorrhaphy groinpain who received tailoredneurectomywas used to study our neurectomy patients showed that half of the population wasexcluded from further analysis because of studentship, retirement, pre-operative occupationaldisability, or unemployment. If these percentages were used in the entire Dutchpopulation, some 220 patients with severe pain are unable to return to their workyearly. Our results show that about half of these patients (n=110) have become occupationallydisabled after their inguinal hernia repair (220/ 2= 110). The total yearly costsfor workers’ compensation in The Netherlands will thus amount to 110 x €29.000 = €3.2million. Without treatment these costs will accumulate every year. In contrast, the costsfor operative neurectomy are only €1300 per person. As previously mentioned, aneurectomy can reduce occupational disability with more than 50%. Thus €1.6 million(50% of €3.2 million) can be saved in The Netherlands per year if all patients on workers’compensation due to severe postherniorrhaphy pain were treated with a neurectomy.Occupational disabilitydue to postherniorrhaphypain (total n=13:partial n=7, complete n=6)Contacted by telephone(n=48)Response rate 89%No occupational disabilityprior to groin hernia repair(n=28)Excluded (n=20)- Retired (n=7)- Student (n=3)- Pre-operativedisability due toother reasons (n=10)No occupationaldisability due topostherniorrhaphypain (n=15)DISCUSSIONPain-induced occupational disability after routine inguinal hernia repair should be considereddisastrous. This complication probably affects half of the patients with severepostherniorrhaphy groin pain (some 1% of all operated patients) 1-3 . Adequate treatmentof these pain syndromes is vital for the patient’s physical and mental health status.Considering only a few studies report on the effect of neurectomy on occupationaldisability 13,15,16,28 , some 56 to 100% of the neurectomized patients were again able torejoin the working process. Moreover, there is no report on patients becoming moredisabled after a neurectomy. However, it should be realized that the data were oftenincomplete and inconsistent. It is obvious that the current body of literature on theTreatment costsOperative neurectomy € 1.300(Including operative costs, hospital admission, visits at outpatient clinic)Occupationaldisabilitydissolved afterneurectomy(total n=7:same work n=6,other work n=1Occupationaldisability didnot dissolve afterneurectomy(total n=6:partial n=2,complete n=4)No occupationaldisability afterneurectomy(n=15)Occupationaldisability afterneurectomy(n=0)Workers’ compensation (per year)Average salary over 10 years € 27.000Additional costs € 2.000(replacement, loss of productivity)Cost-effectiveness of successful neurectomy€ 27.700 (first year)in a patient on workers’ compensation€ 29.000 (following year)Figure 1 Flow chart of occupational disability in patients receiving neurectomy for chronic postherniorrhaphy groin pain.Table 3 Cost-benefit analysis.130 Chapter 9Occupational disability due to chronic postherniorrhaphy neuralgia: a plea for tailored neurectomy 131