“Aggressiveness” of groin hernioplasties. Inguinodynia and influence of approaches, techniques and critical areas of neuropathic risk. “Prophylaxis”

Abstract

Chronic postoperative inguinal pain (somatic or neuropathic) is the most frequent, important and limiting sequela of inguinal hernia surgery, whose exact prevalence is unknown. The work exposes, under a personal, synoptic and objective view, some connotations about the genesis of the inguinal pain types, especially the neuropathic, generated by the technical aggression (invasiveness, dissectivity and reparativity), on specific anatomical areas through which they run the corresponding peripheral inguinal nerves, exposed to neurolesive risks by possible “inappropriate” maneuvers. To improve the understanding of tissue aggressiveness and the possible neurolesive potential of hernioplastic techniques, 2 classifications (personal, unpublished, intuitive and objective) are provided. The first one relates to hernioplastic groups and models with the quantitative dimension (cm) and the qualitative extension of the invasiveness (maxi, norm, mini or minimally invasive), as well as the qualitative extension (maxi, norm and minidisective) and the quantitative dimension of the dissectivity (surface and dissective volume of open and video-assisted techniques). The second classification relates to the same groups and technical models with their respective neurolesive potentials on the respective critical areas of risk of chronic neuropathic pain, according to the probable or unlikely risk of damaging certain nerves in said anatomical areas, also identifying the possible “prophylactic” effect “That could exercise some of the technical options in the” prevention “of chronic neuropathic pain. Undoubtedly, it is the experience, the expertise and the technical-scientific expertise of the surgeon, the best prophylaxis of inguinodynia.