Grip on CPIP:Chronic postoperative inguinal pain

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 have been developed (Lichtenstein, TEP(total extraperitoneal hernioplasty)) which has reduced the recurrence rate to less than five percent. Now the recurrence is not that an issue anymore, an other complication has caught the attention: CPIP. About fifteen percent 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 nerve minded inguinal hernia surgery, is described on the basis of anatomical and clinical studies. Also a new operation technique: TREPP(transrectal extraperitoneal hernioplasty), is described. At least in theory this technique is superior to the traditional Lichtenstein and TEPP. The encouraging results of the first thousand TREPP-operations are reported in this thesis. From a systematic review of the literature it is suggested that there is a relation between expertise of the surgeon and incidence of CPIP. However one must be critical about the way until now research on CIPP is conducted: unfortunately very few uniformity with regard to the use of definitions and methods still exists. This thesis makes a plea to avoid this drawback to 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