Can Nerve Detection be Performed with Dermatome Mapping in Open Hernia Repair?
- 1. Department of General Surgery, Kukës Regional Hospital, Kukës, Albania.
- 2. Department of General Surgery, Spitali Rajonal Memorial, Fier, Albania.
- 3. Department of General Surgery, Ankara City Hospital, University of Health Sciences, Ankara, Turkey.
Description
Abstract
Inguinal hernia repair is one of the most common surgical procedures in the world. Currently, recurrence rates have reduced to less than 5% after mesh repair, but chronic groin pain (CGP) remains a major concern in open hernia surgery. The aim of the study was to detect neuropathic pain associated with iatrogenic nerve damage using the dermatome mapping test (DMT) and to evaluate the preventability of CPG. The study was designed and conducted as a prospective longitudinal observation study in postoperative open hernioplasty patients. The study included 71 adult patients with a primary inguinal hernia, who underwent a standard open surgical procedure for hernia repair using a polypropylene mesh (Lichtenstein’s technique). The dermatome mapping classification was performed in each patient, and the test results were recorded. Seven (9.9%) patients with surgery-related pain lasting for three months or longer after surgery were considered to have CGP, and pain was related to iatrogenic nerve damage in two of these cases. Based on the results, we consider that the anatomical location of the nerves can be easily determined using DMT, and CGP can be prevented.
Özet
Kasık fıtığı tamiri dünya çapında en sık gerçekleştirilen cerrahi uygulamalardan biridir. Günümüzde açık kasık fıtığı onarımında meş kullanımından sonra nüks oranları %5'in altına düşmüş, ancak kronik kasık ağrısı (CGP, chronic groin pain) açık fıtık cerrahisinde önemli bir endişe olmaya devam etmektedir. Çalışmanın amacı açık fıtık tamiri prosedüründe iyatrojenik sinir hasarına bağlı gelişen nöropatik ağrıyı dermatom haritalama yöntemi (DMT) ile belirlemek ve CPG’nin önlenebilirliğini değerlendirmektir. Çalışma, ameliyat sonrası açık hernioplasti hastalarında bir prospektif longitidunal gözlem çalışması olarak tasarlandı ve yürütüldü. Bu çalışmaya primer kasık fıtığı olan ve her birine fıtık onarımı için polipropilen mesh kullanılarak (Lichtenstein tekniği) standart açık cerrahi prosedür uygulanan 71 erişkin hasta dahil edildi. Her bir hasta için dermatom haritalama sınıflandırması prosedürü uygulandı ve sonuçlar kaydedildi. Ameliyatla ilişkili postoperatif ağrısı 3 ay ve daha uzun süren yedi (%9.9) hasta CGP hastası olarak kabul edildi ve bu vakaların ikisinde ağrının iyatrojenik sinir hasarı ile ilişkili olduğu belirlendi. Bu sonuçlara dayalı olarak DMT ile sinirlerin anatomik yerleşiminin kolaylıkla belirlenebileceğini ve CGP'nin önlenebileceğini düşünüyoruz.
Notes
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