Neuromodulation for Intractable Abdominal Pain after Laparoscopic Repair of Epigastric Ventral Hernia
INTRODUCTION
Laparoscopic ventral hernia repair was introduced in 1993 and benefits of this technique are uncertain in comparison to open repair. Up to 9.1 % of patients who undergo this procedure experience chronic abdominal pain (1). The visceral component of pain was identified as main source of pain compared with incisional component (2). Chronic abdominal pain in the patient who exhausted all conventional treatment can be difficult to control. Recently spinal cord stimulation (SCS) has been used to treat patients with chronic abdominal pain (3). We report successful treatment of chronic abdominal pain developed after laparascopic ventral hernia repair with SCS. Neuromodulation for Intractable Abdominal Pain after Laparoscopic Repair of Epigastric Ventral Hernia
MATERIALS AND METHODS
A 26 year old male presented with two year history of chronic abdominal pain. Conservative treatment, including surgical wound exploration, trigger point injections, celiac plexus block, intercostal and epidural injections gave the patient no relief. He underwent successful trial of percutaneous placement of two 8-electrode epidural leads (Medtronic Inc., Minneapolis, MN). Epidural access was gained at the T12/L1 interspace with final leads positioned at T6-T7-T8 (Figure 1). During SCS trial patient reported greater than 90% improvement of the pain and two weeks later underwent placement of permanent leads and Restore ULTRA rechargeable generator.
RESULTS
After final implantation of permanent leads and generator, the patient had excellent pain relief. He was able to discontinue use of all oral pain medications. The patient also reported other positive outcomes including the ability to return to work, social activities and sporting activities along with improved family relationships.
FIGURES
F i g u r e 1
CONCLUSIONS
SCS may be a therapeutic alternative for patients with chronic intractable abdominal pain after laparoscopic ventral hernia repair who in the past exhausted all available treatments. This technique represents an alternative to surgical exploration and other interventional pain treatments. The therapy is reversible should patients lose its pain-alleviating effect or if abdominal pain resolves.
REFERENCES
1. Pham CT, Perera CL, Watkin DS, Maddern GJ. Laparoscopic ventral hernia repair: a systematic review.Surg Endosc 2009;23:4-15.
2. Eriksen JR, Poornoroozy P, Jorgensen LN, Jacobsen B, Friis-Andersen HU, Rosenberg J. Pain, quality of life and recovery after laparoscopic ventral hernia repair. Hernia 2009;13:13-21.
3. Yakovlev AE, Resch BE. Treatment of intractable abdominal pain patient with Bannayan-Riley-Ruvalcaba syndrome using spinal cord stimulation. WMJ 2009;108(6):35-38.
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