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Chronic groin pain (Inguinodynia) following inguinal hernia repair is a significant, though under-reported problem. Mild pain lasting for a few days is common following mesh inguinal hernia repair. However, moderate to severe pain persisting more than 3 mo after inguinal herniorrhaphy should be considered as pathological.

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[Persistent post-operative pain].

Folia Med Cracov

February 2009

Zakład Badania i Leczenia Bólu Katedry Anestezjologii CM UJ, Kraków.

Persistent post-operative pain is defined as a pain in the location of the surgery that persist for many months or even years beyond the usual course of an acute injury and is different of that suffered preoperatively. Persistent pain can be due to long lasting nociception caused by processes such as information, chronic infection or tumor. The most important causes are neuropathic pain states due to nerve compression, entrapment or other damage.

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A case is presented of a patient who sustained bilateral acetabular fractures in a motor vehicle crash. On the right, he sustained a variant associated posterior wall transverse fracture, with a femoral nerve lesion noted preoperatively. Open reduction and internal fixation of both fractures was performed in a staged fashion with an ilio-inguinal approach on the right.

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Laparoscopic techniques currently constitute an alternative proposed for the repair of hernias of the inguinofemoral region. Nerve injuries have led some teams to recommend technical principles based on the anatomical relations of these nerves with the subperitoneal fascia transversalis and inguinal fossae. An anatomical study consisting of dissection of nonembalmed cadavres, allowed, after evisceration, dissection of the lumbar plexus and its terminal branches, particularly those supplying the inguinofemoral region: iliohypogastric and ilio-inguinal nerves, the genitofemoral nerve, the femoral nerve and the lateral cutaneous nerve of the thigh.

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