Álvarez QR, Anaya PR, Malé VE

Language: Spanish
References: 9
Page: 265-269
PDF size: 82.24 Kb.

ABSTRACT

Introduction: Diagnostic evaluation of patients with inguinodynia, determination of its therapeutics, and its prevention are constant and polemic challenges. We propose a diagnostic tool consisting in dermatomes mapping to evaluate the cases of neuropathic and non-neuropathic inguinodynia. Besides, this technique will provide orientation on the most adequate therapeutics.
Setting: Private health care institution.
Objective: To analyze the occurrence of inguinodynia in our patients and those referred by other institutions to be able to find the flowchart for the most adequate evaluation to determine the types of inguinodynia, as well as the affected regions, with a clinical and anatomopathological correlation.
Patients and methods: We performed a retrospective observational study, which included all patients subjected to inguinoplasty who presented inguinodynia after surgery. Evaluation was performed with the dermatome mapping technique using a blunt stimulator and indelible markers to delimit the compromised regions.
Results: From May 1998 to May 2004, 536 inguinoplasties were performed in 427 men and 109 women. The Lichtenstein technique was used in 492 patients, PHS in 5, HERD in 17, Shouldice in 21, and Mercy in 1. All inguinodynia cases were reviewed with a follow-up of at least six months and a maximum of 6 years. The ilioinguinal nerve was the most frequently involved both in the dermatomes evaluation as in the surgical exploration. The mapping technique had a diagnostic sensitivity of 100%.
Conclusion: Dermatomes mapping is an excellent diagnostic option to approach the patient with inguinodynia in its diverse presentations. Its high specificity and easy implementation provide a very useful tool for the diagnosis and treatment of patients with painful groin.

REFERENCES

1. Bower S, Moore BB, Weiss SM. Neuralgia after inguinal hernia repair. Am Surg 1996; 62: 664-7.

2. Stulz P, Pfeiffer KM. Peripheral nerve injuries resulting from common surgical procedures in the lower portion of the abdomen. Arch Surg 1982; 117: 324-7.

3. Lichtenstein IL, Shulman AG, Amid PK, Montllor MM. Cause and prevention of postherniorrhaphy neuralgia; a proposed protocol for treatment. Am J Surg 1988; 155: 786-90.

4. Harms BA, De Haas DR Jr, Starling JR. Diagnosis and management of genitofemoral neuralgia. Arch Surg 1984; 119: 339-41.

5. Aszmann OC, Dellon ES, Dellon AL. Anatomical course of the lateral femoral cutaneous nerve and its susceptibility to compression and injury. Plast Reconstr Surg 1997; 100: 600-4.

6. Fitzgibbons RJ Jr, Camps J, Cornet DA, Nguyen NX, Litke BS, Annibali R, et al Laparoscopic inguinal herniorrhaphy. Results of a multicenter trial. Ann Surg 1995; 221: 3-13.

7. Kopell HP, Thompson WA, Postel AH. Entrapment neuropathy of the ilioinguinal nerve. N Engl J Med 1962; 266: 16-9.

8. Nahabedian MY, Dellon AL. Outcome of the operative management of nerve injuries in the ilioinguinal region. J Am Coll Surg 1997; 184: 265-8.

9. Cunningham J, Temple WJ, Mitchell P, Nixon JA, Preshaw RM, Najen NA. Cooperative hernia study. Pain in the post-repair patient. Ann Surg 1996; 224: 598-602.