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Post herniorrhaphy pain syndrome, or inguinodynia is pain or discomfort lasting greater than 3 months after surgery of inguinal hernia. Randomized trials of laparoscopic vs open inguinal hernia repair have demonstrated similar recurrence rates with the use of mesh and have identified that chronic groin pain (>10%) surpasses recurrence (<2%) and is an important measure of success.
Outside the United States, PTNS is also used to treat fecal incontinence. PTNS can be used as a primary therapy. Treatment for overactive bladder and fecal incontinence may begin with pharmacological therapies before PTNS is administered. Unlike the variety of OAB drugs available PTNS is more effective and produces far fewer side-effects. [1]
Laparoscopic surgery generally has less pain following the procedure. [1] [9] In 2015 inguinal, femoral and abdominal hernias affected about 18.5 million people. [10] About 27% of males and 3% of females develop a groin hernia at some time in their life. [1] Groin hernias occur most often before the age of one and after the age of fifty. [2]
Inguinal hernia surgery is an operation to repair a weakness in the abdominal wall that abnormally allows abdominal contents to slip into a narrow tube called the inguinal canal in the groin region. There are two different clusters of hernia: groin and ventral (abdominal) wall. Groin hernia includes femoral, obturator, and inguinal. [1]
The onset of incontinence should be at least 6 months ago. [6] It has been recommended that this procedure should be attempted only if non-surgical options have failed (such as pharmacologic, behavioral, pelvic floor rehabilitation), [ 6 ] and also if injectable bulking agents were unsuccessful. [ 1 ]
The surgery should aim to release the trunk of the nerve throughout its course (i.e., at all levels of potential entrapment), and to restore the mobility of the nerve. [16] [17] Nerve decompression surgery is indicated if non surgical treatment options are unsuccessful or provide insufficient pain relief.
[7] [2] Its use is limited by side effects such as dry mouth, constipation and decreased sweating. Patients must also be monitored for newly-developed difficulty emptying the bladder, which may result from excessive effects of the drug. [2] Tolterodine is a longer acting anticholinergic that may have fewer side effects. [9]
Complications of the surgery are rare, including pain and infection, which may require implant removal in 5% of cases. The effects of SNS may include increased resting and squeeze anal tone, and improved rectal sensitivity. There is reported reduction of involuntary loss of bowel contents and increased ability to postpone defecation.