Chronic Groin Pain After Hernia Repair

Definition: Pain that lasts > 3 months after a hernia repair
- 5-7% with groin pain will go to litigation

Management of inguinodynia:

- NSAIDs

- Pain clinics

- nerve blocks

Ref: Palumbo et al, "for algorithm for management of persistent groin pain

Risk factors for groin pain:-Recurrent hernia
- high pain scores at 1 and 6 weeks

Types of Post-op Pain:

- Nerve pain. Burning

- Somatic pain. Gnawing

- Testicular pain

Nerves to take into consideration:

Considerations in Inguinal hernia repair:

- Type of mesh. Heavy vs light weight

- Fixaton: Fibrin sealant vs. Staples vs. no fixation

- Most studies have not shown a difference in chronic pain scores based on type (if any) fixation

Use as few tacks as possible and stay above iliopubic Tract

References:
- Courtney BJS 2002. Large Scottish population study
- Grant BJS 2004. Open vs lap hernia numbness and pain is initially lower in the laparoscopic group but  equalize at 5 years
- Eklund. BJS 2010. Chronic pain: At 9 years tep group few have residual pain compare to open group. Low BMI, improvement in function pre to post op lower risk of groin pain.
- Matthews. Am j Surg. 2007. Followup va study. Chonic groin pain

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