Surgical treatment of chronic pain after inguinal hernia repair

Hernia. 2013 Jun;17(3):347-53. doi: 10.1007/s10029-013-1059-x. Epub 2013 Mar 22.


Background: Chronic groin pain is defined as pain arising 3-6 months after inguinal hernia repair that can compromise the patient's quality of life. Many articles in the literature report clinical presentation, but there are no well-defined indications and protocols of treatment.

Methods: Forty-six patients underwent surgical treatment for chronic groin pain that consisted of a simultaneous double approach, anterior and posterior, to the inguinal region, with 44 triple neurectomies and 2 iliohypogastric neurectomies. Ilio-inguinal and ilio-hypogastric nerves were resected by anterior approach, while genitofemoral trunk was resected by a posterior pre-peritoneal approach. Mesh was removed in 24 cases, and mesh and plug were removed in 16 cases. A new mesh repair was performed in 42 cases. All the patients were examined 1 week, 1 month and 1 year postoperatively.

Results: In 40 patients, the surgical treatment has obtained good response with improvement or complete resolution of the pain. Two patients referred persistent groin pain different from preoperative and in 4 cases the pain persisted without substantial benefit. Mean VAS value was 7.89 before surgery and 1.89 after surgery.

Conclusions: Choice of the adequate therapy of chronic groin pain after inguinal hernia repair is still controversial. Our surgical approach turned out to be a safe and effective procedure. In this way, an accurate exploration of the whole inguinal region can be performed along with the identification of the nerves involved. Anyway in a certain number of cases, the resolution of pain cannot be achieved; this suggests a possible involvement of differences in the single personality and tolerances of pain in the different patients.

MeSH terms

  • Chronic Pain / etiology
  • Chronic Pain / surgery*
  • Device Removal
  • Hernia, Inguinal / surgery
  • Herniorrhaphy / adverse effects*
  • Humans
  • Inguinal Canal / innervation
  • Middle Aged
  • Pain Measurement
  • Pain, Postoperative / etiology
  • Pain, Postoperative / surgery*
  • Peripheral Nerves / surgery
  • Surgical Mesh / adverse effects*