Chronic Pain After Inguinal Repair

  • David K. Nguyen
  • David C. Chen


Chronic pain after inguinal hernia repair remains one of the most challenging problems for patients and hernia surgeon alike. Affecting up to 10% of patients, chronic pain can lead to significant disability and affect the patient’s daily activities and ability to work. This chapter will review the complex anatomy and pathophysiology of chronic pain after inguinal hernia repair. It will detail the diagnosis of patients presenting with chronic pain as well as outline the multimodal approach to treatment strategies. Finally, we will review our operative strategy for patients that may benefit from neurectomy to treat this difficult problem.


Inguinal repair Chronic pain Chronic postoperative inguinal pain (CPIP) 


  1. 1.
    Bay-Nielsen M, Thomsen H, Andersen FH, et al. Convalescence after inguinal herniorrhaphy. Br J Surg. 2004;91(3):362–7.CrossRefGoogle Scholar
  2. 2.
    Bittner R, Schwarz J. Inguinal hernia repair: current surgical techniques. Langenbecks Arch Surg. 2012;397(2):271–82.CrossRefGoogle Scholar
  3. 3.
    Macrae WA, HTO D. Chronic postsurgical pain. In: Crombie IK, Linton S, Croft P, Von Korff M, LeResche L, editors. Epidemiology of pain. Seattle: IASP Press; 1999. p. 125–42.Google Scholar
  4. 4.
    Nienhuijs S, Staal E, Strobbe L, Rosman C, Groenewoud H, Bleichrodt R. Chronic pain after mesh repair of inguinal hernia: a systematic review. Am J Surg. 2007;194(3):394–400.CrossRefGoogle Scholar
  5. 5.
    Aasvang E, Kehlet H. Chronic postoperative pain: the case of inguinal herniorrhaphy. Br J Anaesth. 2005;95(1):69–76.CrossRefGoogle Scholar
  6. 6.
    Alfieri S, Amid PK, Campanelli G, et al. International guidelines for prevention and management of post-operative chronic pain following inguinal hernia surgery. Hernia. 2011;15(3):239–49.CrossRefGoogle Scholar
  7. 7.
    Poobalan AS, Bruce J, Smith WC, King PM, Krukowski ZH, Chambers WA. A review of chronic pain after inguinal herniorrhaphy. Clin J Pain. 2003;19(1):48–54.CrossRefGoogle Scholar
  8. 8.
    Cunningham J, Temple WJ, Mitchell P, Nixon JA, Preshaw RM, Hagen NA. Cooperative hernia study. Pain in the postrepair patient. Ann Surg. 1996;224(5):598–602.CrossRefGoogle Scholar
  9. 9.
    Hakeem A, Shanmugam V. Current trends in the diagnosis and management of post-herniorraphy chronic groin pain. World J Gastrointest Surg. 2011;3(6):73–81.CrossRefGoogle Scholar
  10. 10.
    Kehlet H, Jensen TS, Woolf CJ. Persistent postsurgical pain: risk factors and prevention. Lancet. 2006;367(9522):1618–25.CrossRefGoogle Scholar
  11. 11.
    Kalliomaki ML, Meyerson J, Gunnarsson U, Gordh T, Sandblom G. Long-term pain after inguinal hernia repair in a population-based cohort; risk factors and interference with daily activities. Eur J Pain. 2008;12(2):214–25.CrossRefGoogle Scholar
  12. 12.
    Werner MU, Mjobo HN, Nielsen PR, Rudin A. Prediction of postoperative pain: a systematic review of predictive experimental pain studies. Anesthesiology. 2010;112(6):1494–502.CrossRefGoogle Scholar
  13. 13.
    Hinrichs-Rocker A, Schulz K, Jarvinen I, Lefering R, Simanski C, Neugebauer EA. Psychosocial predictors and correlates for chronic post-surgical pain (CPSP)–a systematic review. Eur J Pain. 2009;13(7):719–30.CrossRefGoogle Scholar
  14. 14.
    Sajid MS, Kalra L, Parampalli U, Sains PS, Baig MK. A systematic review and meta-analysis evaluating the effectiveness of lightweight mesh against heavyweight mesh in influencing the incidence of chronic groin pain following laparoscopic inguinal hernia repair. Am J Surg. 2013;205(6):726–36.CrossRefGoogle Scholar
  15. 15.
    de Goede B, Klitsie PJ, van Kempen BJ, et al. Meta-analysis of glue versus sutured mesh fixation for Lichtenstein inguinal hernia repair. Br J Surg. 2013;100(6):735–42.CrossRefGoogle Scholar
  16. 16.
    Zhang C, Li F, Zhang H, Zhong W, Shi D, Zhao Y. Self-gripping versus sutured mesh for inguinal hernia repair: a systematic review and meta-analysis of current literature. J Surg Res. 2013;185(2):653–60.CrossRefGoogle Scholar
  17. 17.
    Nordin P, Zetterstrom H, Gunnarsson U, Nilsson E. Local, regional, or general anaesthesia in groin hernia repair: multicentre randomised trial. Lancet. 2003;362(9387):853–8.CrossRefGoogle Scholar
  18. 18.
    Kehlet H, Aasvang E. Groin hernia repair: anesthesia. World J Surg. 2005;29(8):1058–61.CrossRefGoogle Scholar
  19. 19.
    Franneby U, Sandblom G, Nordin P, Nyren O, Gunnarsson U. Risk factors for long-term pain after hernia surgery. Ann Surg. 2006;244(2):212–9.CrossRefGoogle Scholar
  20. 20.
    Rab M, Ebmer, Dellon AL. Anatomic variability of the ilioinguinal and genitofemoral nerve: implications for the treatment of groin pain. Plast Reconstr Surg. 2001;108(6):1618–23.CrossRefGoogle Scholar
  21. 21.
    Amid PK, Hiatt JR. New understanding of the causes and surgical treatment of postherniorrhaphy inguinodynia and orchalgia. J Am Coll Surg. 2007;205(2):381–5.CrossRefGoogle Scholar
  22. 22.
    Harms BA, DeHaas DR Jr, Starling JR. Diagnosis and management of genitofemoral neuralgia. Arch Surg. 1984;119(3):339–41.CrossRefGoogle Scholar
  23. 23.
    Starling JR, Harms BA. Diagnosis and treatment of genitofemoral and ilioinguinal neuralgia. World J Surg. 1989;13(5):586–91.CrossRefGoogle Scholar
  24. 24.
    Bradley M, Morgan D, Pentlow B, Roe A. The groin hernia–an ultrasound diagnosis? Ann R Coll Surg Engl. 2003;85(3):178–80.CrossRefGoogle Scholar
  25. 25.
    Ferzli GS, Edwards ED, Khoury GE. Chronic pain after inguinal herniorrhaphy. J Am Coll Surg. 2007;205(2):333–41.CrossRefGoogle Scholar
  26. 26.
    Aasvang EK, Jensen KE, Fiirgaard B, Kehlet H. MRI and pathology in persistent postherniotomy pain. J Am Coll Surg. 2009;208(6):1023–8, discussion 1028–9.CrossRefGoogle Scholar
  27. 27.
    Knockaert DC, Boonen AL, Bruyninckx FL, Bobbaers HJ. Electromyographic findings in ilioinguinal-iliohypogastric nerve entrapment syndrome. Acta Clin Belg. 1996;51(3):156–60.CrossRefGoogle Scholar
  28. 28.
    Ellis RB, Geisse H, Holub BA, et al. Ilioinguinal nerve conduction. Muscle Nerve. 1992;15:1195.Google Scholar
  29. 29.
    Filler A. Magnetic resonance neurography and diffusion tensor imaging: origins, history, and clinical impact of the first 50,000 cases with an assessment of efficacy and utility in a prospective 5000-patient study group. Neurosurgery. 2009;65(4 Suppl):A29–43.CrossRefGoogle Scholar
  30. 30.
    Bushnell MC, Ceko M, Low LA. Cognitive and emotional control of pain and its disruption in chronic pain. Nat Rev Neurosci. 2013;14(7):502–11.CrossRefGoogle Scholar
  31. 31.
    Garnock-Jones KP, Keating GM. Lidocaine 5% medicated plaster: a review of its use in postherpetic neuralgia. Drugs. 2009;69(15):2149–65.CrossRefGoogle Scholar
  32. 32.
    Bischoff JM, Petersen M, Uceyler N, Sommer C, Kehlet H, Werner MU. Lidocaine patch (5%) in treatment of persistent inguinal postherniorrhaphy pain: a randomized, double-blind, placebo-controlled, crossover trial. Anesthesiology. 2013;119(6):1444–52.CrossRefGoogle Scholar
  33. 33.
    Derry S, Sven-Rice A, Cole P, Tan T, Moore RA. Topical capsaicin (high concentration) for chronic neuropathic pain in adults. Cochrane Database Syst Rev. 2013;(2):CD007393.
  34. 34.
    Mick G, Correa-Illanes G. Topical pain management with the 5% lidocaine medicated plaster—a review. Curr Med Res Opin. 2012;28(6):937–51.CrossRefGoogle Scholar
  35. 35.
    Bjurstrom MF, Nicol AL, Amid PK, Chen DC. Pain control following inguinal herniorrhaphy: current perspectives. J Pain Res. 2014;7:277–90.PubMedPubMedCentralGoogle Scholar
  36. 36.
    Aasvang E, Kehlet H. Surgical management of chronic pain after inguinal hernia repair. Br J Surg. 2005;92(7):795–801.CrossRefGoogle Scholar
  37. 37.
    Moore AM, Bjurstrom MF, Hiatt JR, Amid PK, Chen DC. Efficacy of retroperitoneal triple neurectomy for refractory neuropathic inguinodynia. Am J Surg. 2016;212:1126–32.CrossRefGoogle Scholar

Copyright information

© Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) 2019

Authors and Affiliations

  1. 1.Department of SurgeryKaiser Permanente Northern CaliforniaOaklandUSA
  2. 2.Section of Minimally Invasive Surgery, UCLA Division of General SurgeryLichtenstein Amid Hernia Clinic at UCLALos AngelesUSA

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