behind the knife, the surgery podcast,

where we take a behind the scenes intimate look

at surgery from leaders in the field.

Hey, everybody. It's great to be back with you all. I'm happy to be back with Dr. Andrew Wright and Nick Citruvo for our first clinical challenge podcast,

in which we will be discussing, unfortunately, common pathology, which is confusing to many surgical trainees and staff alike.

The management of posting will hurt your repair growing pain. Dr. Citruvo, you want to get us started instead of the stage for our listeners,

and why they should care about posting will hurt your repair growing pain?

Sure. Ingrill Hernier repair is definitely one of the most common operations performed by general surgeons, especially in the United States.

This can be done open laposcopic or robotic. We'll try to use the term minimally invasive or open to describe the different options for repair.

20% of patients will have some form of pain after they're hurting your pair of three to 12 months after the operation and an additional 10% of those people

will have pain such that it will actually limit their normal daily activities.

Only a small percentage of these patients, about 2% go on to require surgical intervention or any other procedural intervention.

The frequency of the chronic pain combined with the massive numbers, almost a million Ingrill Hernier repairs,

performed annually in the United States with 20 million word worldwide, makes an imperative that any general surgeon who's performing these procedures and repairs,

at least knows how to start the evaluation management of these post-op complications.

The first step in thinking about chronic pain after Ingrill Hernier repair is realizing that pain is really a symptom and not a diagnosis.

And there are lots of different ideologies of chronic growing pain that have different treatment algorithms.

I think it's also important to realize that the preponderance of growing pain in the general population is actually quite high, and not all pain in the growing, even after somebody's had a hernier repair, is actually due to the repair itself.

So you have to be very thoughtful about approaching these patients and really work through a very good history and physical as well as a review of imaging to start to sort out what might be the potential ideology of their pain.

Very broadly speaking, when you talk about specifically about growing pain due to hernier repair, there are sort of two different phenotypes.

And those phenotypes really help guide the direction of your evaluation in the management.

So the first phenotype is a neuropathic pain.

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