Abstract
Purpose: The ubiquitous use of synthetic materials in hernia surgery has brought about a new clinical syndrome: Surreptitious Irreversible Neuralgia (SIN). It is surreptitious because it is of slow onset, unsuspected and enigmatic to clinicians; irreversible because the pain is progressive, unrelenting and unresponsive to treatment. Removal of the mesh does not guarantee pain relief. Neuralgia following mesh insertion, when it occurs, remains a poorly understood phenomenon. Methods: Ten specimens in each group: virgin tissue, scar tissue and explanted mesh from the posterior inguinal wall were examined histologically to assess nerve density, nerve size and nerve and vessel ingrowth into the deformed mesh and within its pores. Results: There was no signifi- cant difference in nerve density between virgin, scar and mesh samples. All of the explanted meshes had nerves within the scar tissue encasing the mesh (interstitial infiltration). Nerve in- growth through the pores of the mesh (micro-entrapment) was detected in 90% of the explanted mesh specimens. Additionally, nerves were detected entrapped within the folds and deformations of mesh explants. Ingrown vessels showed congestion and focal fibrin thrombi. Conclusion: The presence of mesh does not significantly affect nerve density, while the nerves and their terminal ends are in a vulnerable position about the mesh and within its pores. These pores need to be viewed as mini-compartments of biological tissue where the vasculature, nerves and their re- ceptors are exposed to potential mechanical and chemical factors: scarring, entrapment, compres- sion, tugging, deformation, contraction, hypoxia/acidosis, inflammation and edema.
Highlights
There has been, in the sphere of abdominal wall reconstruction, what can only be described as a tidal wave of olefins submerging the operating rooms of the world
To test whether the presence of mesh has an effect on innervation of scar tissue, we investigated nerve density and distribution in virgin tissue sampled at operative sites during primary hernia repairs as well as in tissues sampled during non-mesh recurrent hernia repairs and mesh explants
After approval by the Shouldice Hospital administration for ethical considerations, the following 30 samples were collected starting January 2013: virgin tissue from the posterior wall of the inguinal canal of 10 primary inguinal hernia repairs, scar tissue from the posterior inguinal wall of 10 hernias which had previously been repaired by pure tissue repair, and 10 mesh explants of hernias which had previously been repaired with monofilament polypropylene mesh as an onlay (Lichtenstein)
Summary
There has been, in the sphere of abdominal wall reconstruction, what can only be described as a tidal wave of olefins submerging the operating rooms of the world. Polypropylene, the most extensively used olefin [1] [2] has helped displace Pure Tissue Repairs of inguinal hernias to contribute to the “new gold standard” in hernia repairs—the Tension Free Repair [3]-[8]. While the best results with mesh repairs have not outperformed the best Pure Tissue Repairs [10] in the hands of experts, the new emerging problem is that of pain, post-operative pain currently described as inguinodynia. To test whether the presence of mesh has an effect on innervation of scar tissue, we investigated nerve density and distribution in virgin tissue sampled at operative sites during primary hernia repairs as well as in tissues sampled during non-mesh recurrent hernia repairs and mesh explants. The mesh in question is polypropylene, the most widely used polymer in hernia repair [1] [2]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
