Pain In Inguinal Region Research Articles

The effect of physical therapy and mechanical stimulation on dysfunction of lower extremities after total pelvic exenteration in cervical carcinoma patient with rectovesicovaginal fistula induced by radiotherapy: a case report

BackgroundTotal pelvic exenteration is the ultimate solution for rectovesicovaginal fistula caused by radiation therapy, yet total pelvic exenteration frequently causes intraoperative complications and postoperative complications. These complications are responsible for the dysfunction of lower extremities, impaired quality of life, and even the high long-term morbidity rate, thus multidisciplinary cooperation and early intervention for prevention of complications are necessary. Physical therapy was found to reduce the postoperative complications and promote rehabilitation, yet the effect on how physiotherapy prevents and treats complications after total pelvic exenteration and pelvic lymphadenectomy remains unclear.Case presentationA 50-year-old Chinese woman gradually developed perianal and pelvic floor pain and discomfort, right lower limb numbness, and involuntary vaginal discharge owing to recurrence and metastasis of cervical cancer more than half a year ago. Diagnosed as rectovesicovaginal fistula caused by radiation, she received total pelvic exenteration and subsequently developed severe lower limb edema, swelling pain, obturator nerve injury, and motor dysfunction. The patient was referred to a physiotherapist who performed rehabilitation evaluation and found edema in both lower extremities, right inguinal region pain (numeric pain rate scale 5/10), decreased temperature sensation and light touch in the medial thigh of the right lower limb, decreased right hip adductor muscle strength (manual muscle test 1/5) and right hip flexor muscle strength (manual muscle test 1/5), inability actively to adduct and flex the right hip with knee extension, low de Morton mobility Index score (0/100), and low Modified Barthel Index score (35/100). Routine physiotherapy was performed in 2 weeks, including therapeutic exercises, mechanical stimulation and electrical stimulation as well as manual therapy. The outcomes showed that physiotherapy significantly reduced lower limb pain and swelling, and improved hip range of motion, motor function, and activities of daily living, but still did not prevent thrombosis.ConclusionStandardized physical therapy demonstrates the effect on postoperative complications after total pelvic exenteration and pelvic lymphadenectomy. This supports the necessity of multidisciplinary cooperation and early physiotherapy intervention. Further research is needed to determine the causes of thrombosis after standardized intervention, and more randomized controlled trials are needed to investigate the efficacy of physical therapy after total pelvic exenteration.

Use of mesh fixation device in inguinal hernia

Background: With attention to patient outcome after open inguinal hernia chronic inguinal region pain and discomfort are major complains due to nerve compression by sutures used for mesh fixation. Objectives to compare outcomes of mesh fixation with metallic versus delayed absorbable suture material in inguinal hernia through laparoscopic surgery. Methods: This was prospective study conducted at department of general surgery in a Prime hospital, Dubai during the period of January 2022 to December 2022. Prior approval of local ethical committee was obtained. Total 100 male patients who underwent laparoscopic surgery were included in the study. Patients were split into two groups of 50 each. Metallic suture material (Tantallum 1-0) was used to fix the mesh in group 1 while mesh fixation was used in group 2 was completed with Vicryl 2-0, a delayed absorbable suture material. SPSS was used for analysis. Results: There was appearance of post-operative pain in 20 patients, 10 patients, and 7 patients after 10 days, after 1 month and after 3 months, respectively in group 1 while for group 2, post-operative pain appeared in 12 patients, 4 patients, and 2 patients after 10 days, after 1 month and after 3 months, respectively. As such there was no statistically significant difference was found between two groups except for the appearance of the post-operative pain after 1 month (p<0.05). Conclusions: The recurrence rates for the two approaches are statistically equivalent. As a result, delayed absorbable material may be an effective mesh fixation substitute.

Filariasis Diagnosed by Real Time Sonographic Imaging as Filarial Dance Sign: A Case Report

Lymphatic filariasis is a major public health problem. World Health Organization (WHO) has graded filariasis, as the second leading cause for permanent and long-term disability after leprosy. It is a chronic disabling parasitic disease prevalent in South Asia and Africa. A case of 26-year-old male resident of district Palpa presented with swelling of left inguinal region since 3-4 days and pain in inguinal region since a month. He had no history of trauma, fever or any other systemic symptoms. High frequency, high-resolution scrotal ultrasonography is a valuable technique for diagnosing scrotal filarial infection. This method revealed “Filarial Dance Sign” which is a distinctive and continuous pattern of movement of live microfilaria indicating active infection. It is a simple, rapid, sensitive and noninvasive technique. Noninvasive ultrasonography is preferable to the invasive FNAC.

Sandwich technique, peripheral nerve stimulation, peripheral field stimulation and hybrid stimulation for inguinal region and genital pain

Objective: Ilioinguinal neuralgia (IG) and genitofemoral (GF) neuralgia following inguinal hernia repair is a chronic and debilitating neuropathic condition. Recently, peripheral nerve stimulation has become an effective and minimally invasive option for the treatment of refractory pain. Here we present a retrospective case series of six patients who underwent placement of peripheral nerve stimulation electrodes using various techniques for treatment of refractory post-intervention inguinal region pain.Methods: Six patients with post-intervention inguinal, femoral or GF neuropathic pain were evaluated for surgery. Either octopolar percutaneous electrodes or combination of paddle and percutaneous electrodes were implanted in the area of their pain. Pain visual analog scores (VAS), surgical complication rate, preoperative symptom duration, degree of pain relief, preoperative and postoperative work status, postoperative changes in medication usage, and overall degree of satisfaction with this therapy was assessed.Results: All six patients had an average improvement of 62% in the immediate post-operative follow-up. Four patients underwent stimulation for IG, one for femoral neuralgia, and another for GF neuralgia. Peripheral nerve stimulation provided at least 50% pain relief in all the six patients with post-intervention inguinal region pain. 85% of patients indicated they were completely satisfied with the therapy overall. There was one treatment failure with an acceptable complication rate.Conclusion: Peripheral nerve or field stimulation for post-intervention inguinal region pain is a safe and effective treatment for this refractory and complex problem for patients who have exhausted other management options.

Ilioinguinal neurectomy in open inguinal hernia mesh repair

Objectives: To evaluate the long-term impact of ilioinguinal neurectomy on the incidence of postoperative neuralgia and paraesthesia following the tension free Lichtenstein`s hernia repair. Study design: Case Descriptive Study. Place and duration of study: DHQ Hospital, Faisalabad (January 2003 - January 2005). Patients and methods: A total of 200 patients having unilateral inguinal hernia were included in the study. After a detailed history, patients were subjected to standard Lichtenstein inguinal hernioplasty. All patients underwent elective ilioinguinal neurectomy at the time of hernioplasty. Postoperative pain and paraesthesia were recorded and categorized on a mild, moderate or severe scale. Patients were followed 1 month, 6month and 1 year postoperatively. Results: The incidence of chronic pain was 9% at 1 month & 6% at 6 months and 1 year postoperatively. None of the patients developed severe persistent pain in inguinal region. The incidence of post operative paraesthesia showed a continuous decli ne. It was 32% at 1 month, 24% at 6 month and 19% at 1 year of follow up. The paraesthesia was never severe or bothersome at the end of the follow up period. Conclusion:Routine ilioinguinal neurectomy significantly reduces the chronic post-hernioplasty inguinal pain. Moreover it is safe to perform & well tolerated by the patients.

Comparative study of mesh fixation with non-absorbable v/s delayed absorbable suture in open inguinal hernia

Background: With attention to patient outcome after open inguinal hernia chronic inguinal region pain and discomfort are major complains due to nerve compression by sutures used for mesh fixation. Traditionally mesh is fixed with non-absorbable suture material. Objective of the study was this study planned with the objective to compare post-operative outcomes of mesh fixation with non-absorbable v/s delayed absorbable suture material. Methods: This was prospective study conducted at Department of general surgery GMERS medical collage sola, Ahmadabad, Gujarat during the period of January 2013 to May 2014. Total 100 male patients who underwent Lichtenstein tension free inguinal hernioplasty were included in the study. Patients were divided in 2 groups each of 50 patients. In group 1 mesh fixation was done with non-absorbable suture material (proline 1-0) and in group 2 mesh fixation was done with delayed absorbable suture material (vicryl 2-0).. Results: The development of post-operative pain was more common in in group 1 as compared to group 2. If we compare the appearance of post-operative paresthesia in both surgical groups, there was more number of patients had developed paresthesia group 1 as compared to group 2. But there was no statistical significant difference was found between two groups. There was more number of patients had developed complications group 1 as compared to group 2 barring ecchymosis which was more common in group 2. Recurrence of hernia was observed in 2 patients in group 1 while in 1 patient in group 2 without statistical significant difference (p-value: 0.56). Conclusions: By using delayed absorbable material with Air knot in mesh fixation for Lichtenstein open inguinal herniolasty we found there is less postoperative groin pain and paraesthesia, with regards to recurrence there is no significant statistical difference in both groups therefore delayed absorbable suture material can be used safely for mesh fixation .

The observation of follow-up and application of the prolene hernia system in inguinal hernioplasty of aged patients

Objective To explore applied characteristics of the prolene hernia system(PHS) in inguinal hernioplasty, and management during and after operation, and long-term effect of this kind of hemioplasty in aged patients. Methods 69 aged patients using PHS were followed and analyzed retrospectively. Results Tension-free inguinal hernioplasty with the PHS were performed in 69 aged patients of groin hernia. Operative time ranged from 45min to 160min. Post-operatively, 3 patients developed gentle scrotal swelling, and 20 patients had been adminis- tered anodyne for pain of incision, and 12 cases experienced retention of urine, 1 case developed pneumonia, and 2 cases oeeurred incisional infection and gore. 68 cases of them recovered daily life about 2 to 3 weeks after operation. During follow-up period from 6 months to 77 months,there was no recurrence of inguinal hernia and no pain in in-guinal region, but 2 patients feel discomfort sporadically. Conclusion The PHS strengthens the myopectineal orifice and seals up-area of it,so the system is especially preferred in treating aged patients of groin hernias who have some defectsof anatomic structure in inguinal region. The local anaesthesia is also suitable for this kind of hernioplasty in aged patients.

Manipulative Treatment of Hip Pain in a Ballet Student a Case Study

A 14-year-old female ballet student was referred to physical therapy for examination and treatment of left inguinal region pain. A single session of non-thrust manipulation resulted in an immediate and lasting improvement in symptoms. This case report includes a description of the relevant examination and treatment procedures as well as a discussion of hip instability and the acetabular labrum.