Current trends in the diagnosis and management of post-herniorraphy chronic groin pain

Abstract

Inguinodynia (chronic groin pain) is one of the recognised complications of the commonly performed Lichtenstein mesh inguinal hernia repair. This has major impact on quality of life in a significant proportion of patients. The pain is classified as neuropathic and non-neuropathic related to nerve damage and to the mesh, respectively. Correct diagnosis of this problem is relatively difficult. A thorough history and clinical examination are essential, as is a good knowledge of the groin nerve distribution. In spite of the common nature of the problem, the literature evidence is limited. In this paper we discuss the diagnostic tools and treatment options, both non-surgical and surgical. In addition, we discuss the criteria for surgical intervention and its optimal timing.

Groin Hernias in Adults

“…In patients with persistent pain, strategies for treatment have included mesh and suture excision, neurectomy, and neuroma excision, but there is wide variation in the reported rates of improvement after these interventions in case series. 40,41 Rigorous studies are needed to clarify the efficacy of various treatment strategies. Postherniorrhaphy pain should be discussed as part of informed consent.…”

Laparoscopic Versus Open Preperitoneal Mesh Repair of Inguinal Hernia: an Integrated Systematic Review and Meta-analysis of Published Randomized Controlled Trials

“…Patient-related factors include previous use of analgesics, previous groin operations, anxiety disorders, depressive disorders, impaired immunity, diabetes mellitus and various forms of neurological disorders [7][8][9]. Hernia surgery-related factors include wound haematoma, surgical site infection, regional nerve injury, stitch ligation or entrapment of the regional nerves and tension repair of inguinal hernia [10,11]. Mesh biomaterial in the form of lightweight mesh and heavyweight mesh has also been reported to be involved in the aetiology and pathogenesis of chronic groin pain [12][13][14][15].…”

Lichtenstein mesh hernioplasty: the extreme refinement in hernia surgery

“…Kim et al used gabapentin or oral steroids as second line agents following the failure of NSAIDs. 18 In our study recurrence was seen in 1 (n= 0.5%) patient in 9 th month. The Lichtenstein repair is considered the "gold standard" against which other repairs are compared.…”