Due to the use of prosthetic material in inguinal hernia repair, the recurrence rate has been markedly reduced, and postherniorrhaphy chronic groin pain (inguinodynia) is now the focus of herniologists world-wide. Occasionally, chronic orchalgia occurs in association with groin pain after hernia repair, and it indicates a poor prognosis.
In early 2005, while performing a triple neurectomy (i.e. resection of the ilioinguinal nerve, the iliohypogastric nerve, and the inguinal segment of the genital branch of the genitofemoral nerve)1 on a patient with chronic inguinodynia associated with orchalgia and MRI evidence of vas entrapment by a meshoma,2 the patient's vas deferens was found to be completely encircled by the mesh from a previous hernia repair (Fig. 1). Because the patient had undergone a vasectomy, the affected segment of the vas deferens was resected during the triple neurectomy. The patient's chronic groin pain and orchalgia disappeared postoperatively, which was contrary to our experience with other patients with the same symptoms. Histological analysis of the resected vas deferens showed extensive fibrosis and foreign body reaction around the paravasal nerves within the lamina propria (Fig. 2).
Figure 1.
(Top) MRI image of a meshoma entrapping the vas. (Bottom) Intra-operative photograph of vas entrapped in a meshoma.
Figure 2.
Foreign body reaction of lamina propria around the vas and paravasal nerves.
In five more patients with chronic inguinodynia associated with orchalgia, I resected the lamina propria and the paravasal nerves at the involved segment of the vas deferens during triple neurectomy. In all cases, the orchalgia disappeared postoperatively. The number of patients is too small and follow-up is too short to draw a solid conclusion; however, I wonder whether one of the causes of postvasectomy orchalgia could be perineural fibrosis of the paravasal nerves and whether resection of the lamina propria of the vas during routine vasectomies could prevent paravasal neuropathy as a possible cause of postvasectomy orchalgia.
Footnotes
COMMENT ON doi 10.1308/003588405x71054 NS Awsare, JAI Krishnan, GB Boustead, DC Hanbury, TA McNicholas. Complications of vasectomy. Ann R Coll Surg Engl 2005; 87: 406–10
References
- 1.Amid PK. Causes, prevention, and surgical treatment of postherniorrhaphy neuropathic inguinodynia: Triple neurectomy with proximal end implantation. Hernia. 2004;8:343–9. doi: 10.1007/s10029-004-0247-0. [DOI] [PubMed] [Google Scholar]
- 2.Amid PK. Radiologic images of meshoma. A new phenomenon causing chronic pain after prosthetic repair of abdominal wall hernias. Arch Surg. 2004;139:1297. doi: 10.1001/archsurg.139.12.1297. [DOI] [PubMed] [Google Scholar]