Surgical management of chronic pain after inguinal hernia repair

E Aasvang, H Kehlet
British Journal of Surgery 2005, 92 (7): 795-801

BACKGROUND: Chronic pain after inguinal hernia repair is an adverse outcome that affects about 12 per cent of patients. Principles of treatment have not been defined. This review examines neurectomy and mesh or staple removal as possible treatments.

METHOD: A literature search was carried out using the Medline and Ovid databases. Keywords were 'pain; chronic', 'herniorrhaphy; inguinal', 'neurectomy' and similar words. Article references were cross-checked for additional references. Articles were reviewed for data on surgical treatment of chronic pain after hernia repair.

RESULTS: Neurectomy of the ilioinguinal, iliohypogastric, genitofemoral or lateral femoral cutaneous nerve was described in 14 papers. Overall, a favourable outcome was reported. However, the methodological quality was poor in all studies in respect of preoperative diagnostic criteria and treatment, intraoperative success in identifying a pathological lesion or nerve and quality of follow-up; this hindered interpretation of the data. Insufficient information is available at present on the effect of removal of mesh or staples.

CONCLUSION: Chronic pain after hernia repair is a significant problem and there is a need for a definitive assessment of its surgical treatment.

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