Objective: For many women with chronic pelvic pain (CPP), non-palpable groin hernias represent a common potentially treatable cause. Despite history and physical exam findings which are suggestive of hernia, the lack of a palpable impulse may cause the diagnosis to be missed. Laparoscopic techniques provide a minimally invasive means for evaluating and treating occult hernias in these patients. We present intraoperative findings and short-term follow up results of a series of patients diagnosed with chronic pelvic pain and suspected of having occult hernias.
Methods: Records were reviewed from 325 patients (age range 17-52 years) who underwent laparoscopic exploration for suspected occult hernia at our institution between 1995 and 2007. All patients were treated by a single surgeon. Indications for surgery were 1.) inguinal pain radiating to the labia or thigh 2.) reproduction of pain by internal palpation of the inguinal/femoral ring on bimanual exam by a gynecologist 3.) point tenderness of the deep or superficial inguinal rings on external physical exam. Complaints of inguinal pain ranged from 6 months to 20 years. All patients were treated with transabdominal preperitoneal (TAPP) hernia repair with prosthetic mesh. Follow up was from 3 to 16 months and patients were asked to grade their relief of symptoms as complete, significant, or no change.
Results: In 7 patients (2%) no abnormality was found. An obvious visible indirect hernia was seen prior to preperitoneal dissection in 12% of patients. After preperitoneal dissection, a variety of defects were identified: indirect hernias (77%), large internal ring with incarcerated fat (65%), direct hernia (20%), femoral hernia (40%), obturator hernia (2%), and bilateral hernias (40%). Many patients had multiple abnormalities. 100 patients were repaired with a Gortex mesh fixed with tacks, 125 patients were repaired with an Atrium mesh fixed with tacks, and 100 patients repaired with a 3D Max mesh and no tacks. Overall, 74.69% of patients reported “complete relief” of symptoms, 17.83% had “significant improvement” in symptoms, and 7.48% had “no change” in symptoms.
Conclusions: A variety of abnormalities were found and repaired with the majority of patients reporting complete or significant relief of symptoms. Occult hernias are a common cause of CPP and effective pain relief can be obtained by a diagnostic laparoscopy and laparoscopic repair in carefully selected patients.
Session: Podium Presentation
Program Number: S095
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