Yong, P. J., Williams, C., & Allaire, C. (2013). Laparoscopic inguinal exploration and mesh placement for chronic pelvic pain. JSLS : Journal of the Society of Laparoendoscopic Surgeons. https://doi.org/10.4293/108680812x13517013317310
Yong PJ, Williams C, Allaire C. Laparoscopic inguinal exploration and mesh placement for chronic pelvic pain. JSLS : Journal of the Society of Laparoendoscopic Surgeons. 2013. doi:10.4293/108680812x13517013317310
Yong, Paul J., et al. "Laparoscopic inguinal exploration and mesh placement for chronic pelvic pain." JSLS : Journal of the Society of Laparoendoscopic Surgeons, 2013.
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Groin mesh surgery improved one-sided pelvic pain in 35% of women
Groin mesh surgery improved one-sided chronic pelvic pain in about 35 out of 100 women at the last visit. In this retrospective cohort of 48 women with groin tenderness, 43 had a postoperative visit. Pain improved, then returned, in 42 out of 100. Improvement was more common with a positive Carnett's test, 73 out of 100 versus 22.
Key Findings
At the last postoperative visit, pain had improved in 15 of 43 women (35%), improved then returned in 18 (42%), stayed unchanged in 9 (21%) and worsened in 1 (2%).
Pain improved in 8 of 11 women (73%) with a positive Carnett's test and in 7 of 32 (22%) with a negative test (Spearman's rho = 0.34, P = .024).
A patent processus vaginalis, a dimple or defect in the abdominal lining at the groin, was found in 7 of 48 women (15%) and was not linked to the outcome.
No intraoperative complications occurred; postoperative complications were mild and affected 10%. Eight women (17%) needed reoperation for pain, including repeat laparoscopy for mesh removal in 3.
Of 13 women (27%) who returned a follow-up questionnaire, 9 (69%) reported improved pain, and three SF-36 quality-of-life subscales improved: physical functioning, social functioning and pain.
Interpretation
This retrospective cohort followed 48 women with one-sided pelvic pain, groin tenderness and no hernia on abdominal exam, treated at one referral center. Earlier laparoscopy had been done in 79%. Some women also had endometriosis excised during the same operation. In Carnett's test, tenderness that stays the same or worsens when the abdominal muscles are tensed is positive. A positive test was the only tested factor significantly linked to improvement. The authors note that 27% of women returned the follow-up questionnaire. The findings support larger studies of this surgical approach.
RRM Context
Restorative reproductive medicine looks for the source of pain before choosing a treatment. The authors list muscle, nerve, bowel, bladder and gynecologic causes of chronic pelvic pain. Surgery was offered for groin tenderness to women who had already had long histories, with half in pain for more than 5 years and 35 having had earlier laparoscopy for the same pain.
Our editorial summary of this paper, not the article's abstract.
Abstract
Background and Objectives
Chronic pelvic pain affects 15% of women. Our objective was to evaluate empiric laparoscopic inguinal exploration and mesh placement in this population.
Methods
Retrospective cohort with follow-up questionnaire of women with lateralizing chronic pelvic pain (right or left), ipsilateral inguinal tenderness on pelvic examination, no clinical hernia on abdominal examination, and ipsilateral empiric laparoscopic inguinal exploration with mesh placement (2003-2009). Primary outcome was pain level at the last postoperative visit. Secondary outcomes were pain level and SF-36 scores from the follow-up questionnaire.
Results
Forty-eight cases met the study criteria. Surgery was done empirically for all patients, with only 7 patients (15%) found to have an ipsilateral patent processus vaginalis (shallow peritoneal dimple or a deeper defect (occult hernia)). Of 43 cases informative for the primary outcome, there was pain improvement in 15 patients (35%); pain improvement then return of the pain in 18 patients (42%); and pain unchanged in 9 patients (21%) and worse in 1 patient (2%). Improvement in pain was associated with a positive Carnett's test in the ipsilateral abdominal lower quadrant (P = .024). Thirteen patients returned the questionnaire (27%), and the pain was now described as improved in 9 patients (69%), unchanged in 4 patients (31%), and worse in none. Three SF-36 subscales showed improvement (physical functioning, social functioning, and pain).
Conclusion
In select women with chronic pelvic pain, empiric laparoscopic inguinal exploration and mesh placement results in moderate improvement in outcome. A positive Carnett's test in the ipsilateral abdominal lower quadrant is a predictor of better outcome.
