MRI and pathology in persistent postherniotomy pain

Eske Kvanner Aasvang; Karl-Erik Jensen; Bente Fiirgaard; Henrik Kehlet

doi:10.1016/j.jamcollsurg.2009.02.056

MRI and pathology in persistent postherniotomy pain

Eske Kvanner Aasvang, Karl-Erik Jensen, Bente Fiirgaard, Henrik Kehlet

Department of Clinical Medicine

14 Citations (Scopus)

Abstract

BACKGROUND: Persistent postherniotomy pain impairs everyday life in 5% to 10% of patients. MRI can potentially be useful in the investigation of pathogenic mechanisms and guide surgeons in mesh removal and neurectomy. No study has investigated interobserver agreement or MRI-specific findings in persistent postherniotomy pain. STUDY DESIGN: Thirty-two patients with persistent postherniotomy pain > 1 year after uni- or bilateral groin hernia repair and 6 pain-free postherniotomy controls were MRI scanned, resulting in a total of 32 painful groins, 15 pain-free operated groins, and 29 pain-free unoperated groins scanned. Two blinded observers separately assessed groins using a predefined list of possible MRI pathology and anatomic landmarks. Primary outcomes included interobserver agreement assessed by calculating kappa-coefficients. Secondary outcomes included frequency of MRI pathology in painful groins versus unoperated and pain-free groins. RESULTS: Interobserver agreement was poor, ranging from kappa = 0.24 to 0.55 ("fair" to "moderate") except for "contrast enhancement in groin" (kappa = 0.69, substantial). Pathologic changes in the form of "contrast enhancement in groin," "edema," and "spermatic cord caliber increased" were significantly more often seen in painful versus unoperated groins (p < 0.02). No significant difference was seen when painful and pain-free operated groins were compared (p < 0.05). No pathologic finding was specific or seen in all painful groins. CONCLUSIONS: Interobserver agreement is low and MRI-assessed pathology unspecific for persistent postherniotomy pain. Additional studies are required on interobserver agreement for pathology before MRI can be recommended as guidance and indication for surgical treatment of persistent postherniotomy pain.

Original language	English
Journal	Journal of the American College of Surgeons
Volume	208
Issue number	6
Pages (from-to)	1023-8; discussion 1028-9
Number of pages	6
ISSN	1072-7515
DOIs	https://doi.org/10.1016/j.jamcollsurg.2009.02.056
Publication status	Published - 2009

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10.1016/j.jamcollsurg.2009.02.056

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title = "MRI and pathology in persistent postherniotomy pain",

abstract = "BACKGROUND: Persistent postherniotomy pain impairs everyday life in 5% to 10% of patients. MRI can potentially be useful in the investigation of pathogenic mechanisms and guide surgeons in mesh removal and neurectomy. No study has investigated interobserver agreement or MRI-specific findings in persistent postherniotomy pain. STUDY DESIGN: Thirty-two patients with persistent postherniotomy pain > 1 year after uni- or bilateral groin hernia repair and 6 pain-free postherniotomy controls were MRI scanned, resulting in a total of 32 painful groins, 15 pain-free operated groins, and 29 pain-free unoperated groins scanned. Two blinded observers separately assessed groins using a predefined list of possible MRI pathology and anatomic landmarks. Primary outcomes included interobserver agreement assessed by calculating kappa-coefficients. Secondary outcomes included frequency of MRI pathology in painful groins versus unoperated and pain-free groins. RESULTS: Interobserver agreement was poor, ranging from kappa = 0.24 to 0.55 ({"}fair{"} to {"}moderate{"}) except for {"}contrast enhancement in groin{"} (kappa = 0.69, substantial). Pathologic changes in the form of {"}contrast enhancement in groin,{"} {"}edema,{"} and {"}spermatic cord caliber increased{"} were significantly more often seen in painful versus unoperated groins (p < 0.02). No significant difference was seen when painful and pain-free operated groins were compared (p < 0.05). No pathologic finding was specific or seen in all painful groins. CONCLUSIONS: Interobserver agreement is low and MRI-assessed pathology unspecific for persistent postherniotomy pain. Additional studies are required on interobserver agreement for pathology before MRI can be recommended as guidance and indication for surgical treatment of persistent postherniotomy pain.",

author = "Aasvang, {Eske Kvanner} and Karl-Erik Jensen and Bente Fiirgaard and Henrik Kehlet",

note = "Keywords: Contrast Media; Denmark; Edema; Genital Diseases, Male; Groin; Hernia; Humans; Magnetic Resonance Imaging; Male; Observer Variation; Pain, Postoperative; Surgical Mesh",

year = "2009",

doi = "10.1016/j.jamcollsurg.2009.02.056",

language = "English",

volume = "208",

pages = "1023--8; discussion 1028--9",

journal = "Journal of the American College of Surgeons",

issn = "1072-7515",

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TY - JOUR

T1 - MRI and pathology in persistent postherniotomy pain

AU - Aasvang, Eske Kvanner

AU - Jensen, Karl-Erik

AU - Fiirgaard, Bente

AU - Kehlet, Henrik

N1 - Keywords: Contrast Media; Denmark; Edema; Genital Diseases, Male; Groin; Hernia; Humans; Magnetic Resonance Imaging; Male; Observer Variation; Pain, Postoperative; Surgical Mesh

PY - 2009

Y1 - 2009

N2 - BACKGROUND: Persistent postherniotomy pain impairs everyday life in 5% to 10% of patients. MRI can potentially be useful in the investigation of pathogenic mechanisms and guide surgeons in mesh removal and neurectomy. No study has investigated interobserver agreement or MRI-specific findings in persistent postherniotomy pain. STUDY DESIGN: Thirty-two patients with persistent postherniotomy pain > 1 year after uni- or bilateral groin hernia repair and 6 pain-free postherniotomy controls were MRI scanned, resulting in a total of 32 painful groins, 15 pain-free operated groins, and 29 pain-free unoperated groins scanned. Two blinded observers separately assessed groins using a predefined list of possible MRI pathology and anatomic landmarks. Primary outcomes included interobserver agreement assessed by calculating kappa-coefficients. Secondary outcomes included frequency of MRI pathology in painful groins versus unoperated and pain-free groins. RESULTS: Interobserver agreement was poor, ranging from kappa = 0.24 to 0.55 ("fair" to "moderate") except for "contrast enhancement in groin" (kappa = 0.69, substantial). Pathologic changes in the form of "contrast enhancement in groin," "edema," and "spermatic cord caliber increased" were significantly more often seen in painful versus unoperated groins (p < 0.02). No significant difference was seen when painful and pain-free operated groins were compared (p < 0.05). No pathologic finding was specific or seen in all painful groins. CONCLUSIONS: Interobserver agreement is low and MRI-assessed pathology unspecific for persistent postherniotomy pain. Additional studies are required on interobserver agreement for pathology before MRI can be recommended as guidance and indication for surgical treatment of persistent postherniotomy pain.

AB - BACKGROUND: Persistent postherniotomy pain impairs everyday life in 5% to 10% of patients. MRI can potentially be useful in the investigation of pathogenic mechanisms and guide surgeons in mesh removal and neurectomy. No study has investigated interobserver agreement or MRI-specific findings in persistent postherniotomy pain. STUDY DESIGN: Thirty-two patients with persistent postherniotomy pain > 1 year after uni- or bilateral groin hernia repair and 6 pain-free postherniotomy controls were MRI scanned, resulting in a total of 32 painful groins, 15 pain-free operated groins, and 29 pain-free unoperated groins scanned. Two blinded observers separately assessed groins using a predefined list of possible MRI pathology and anatomic landmarks. Primary outcomes included interobserver agreement assessed by calculating kappa-coefficients. Secondary outcomes included frequency of MRI pathology in painful groins versus unoperated and pain-free groins. RESULTS: Interobserver agreement was poor, ranging from kappa = 0.24 to 0.55 ("fair" to "moderate") except for "contrast enhancement in groin" (kappa = 0.69, substantial). Pathologic changes in the form of "contrast enhancement in groin," "edema," and "spermatic cord caliber increased" were significantly more often seen in painful versus unoperated groins (p < 0.02). No significant difference was seen when painful and pain-free operated groins were compared (p < 0.05). No pathologic finding was specific or seen in all painful groins. CONCLUSIONS: Interobserver agreement is low and MRI-assessed pathology unspecific for persistent postherniotomy pain. Additional studies are required on interobserver agreement for pathology before MRI can be recommended as guidance and indication for surgical treatment of persistent postherniotomy pain.

U2 - 10.1016/j.jamcollsurg.2009.02.056

DO - 10.1016/j.jamcollsurg.2009.02.056

M3 - Journal article

C2 - 19476886

SN - 1072-7515

VL - 208

SP - 1023-8; discussion 1028-9

JO - Journal of the American College of Surgeons

JF - Journal of the American College of Surgeons

IS - 6

ER -

MRI and pathology in persistent postherniotomy pain

Abstract

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