Grip on CPIP
The thesis “Grip on CPIP” focuses on chronic inguinal postoperative pain (CPIP). Since the introduction of the prosthetic mesh several operation techniques to correct inguinal hernia were developed (Lichtenstein, TEP (total extraperitoneal hernioplasty)) which have reduced the recurrence rate to less than 5%. Now the recurrence is not such an issue anymore, another complication has caught the attention: CPIP. About 15% of the inguinal hernia patients suffer from CPIP. “Grip on CPIP” investigates several aspects of this phenomenon. A relation between the three inguinal nerves and CPIP is described. Not all surgeons who perform inguinal hernia surgery are aware of the neuranatomy and the feasibility of inguinal hernia surgery taking into account the nerves is described on the basis of anatomical and clinical studies. Also the new operation technique TREPP (transrectal extraperitoneal hernioplasty) is described. In theory this technique is superior to the traditional Lichtenstein and TEPP. Encouraging results of the first thousand TREPP-operations are reported in this thesis.
Based on a systematic review of the literature it is suggested that there is a relation between expertise of the surgeon and incidence of CPIP. This finding must be viewed in the context that there is still little uniformity regarding the definitions and methods used in CIPP. In this thesis we argue avoiding this drawback in order to gain consistent conclusions on CPIP. Finally, in this thesis an international algorithm for the treatment of CPIP is presented. This algorithm is developed and broadly supported by international experts in the field.