Pain After Inguinal Hernia Repair – What to Do

This is the title of a French article discussing the problem recently.

I have written about handling post hernia surgery problems before here:
Post Hernia Surgery Pain Protocol and Other Options

and had a list of studies:

Post Hernia Surgery Helped by TENS and Should Surgeons be Doing Hernia Repairs if They do Not Know How to Deal with the Persistent Pain Afterwards?

Here is a more recent French protocol:
Rev Med Suisse. 2010 Jun 23;6(254):1288-91.
[Pain after inguinal hernia repair: what to do?]
[Article in French]
Abrazhda D, Hübner M, Foletti A, Demartines N, Vuilleumier H.
free article here (good luck with that)

  • Problem is easily understood when one sees all the nerve that surround the hernia area (dashed area):

  • These nerves will be often damaged by surgery or implantation of mesh and clips
  • 10% of cases no matter what technique used though some think less likely with laparoscopic.
  • They suggest to not do surgery unless you have too – hernia dangerously stuck(incarcerated) in only 1/400 cases
  • pain longer than 3 month is chronic
  • If the pain is more down near the pubic bone, it could be the stitch attachment to pubic bone where local steroid injection might help
  • I was important to differentiate nociceptive (tissue) pains versus neuropathic (nerve) pain:
  • Nociceptive: – tissue damage associated with an inflammatory response – groin pain,  constant,  worse with exertion, with a taut, duller quality
  • Neuropathic -  Nerve damage neuroma pain – Triggering point location,  episodic pain, worse with walking and  sitting; burning and  stabbing quality,  pain to light touch (allodynia), tinels sign – tingling radiation with tapping. [I would have thought numbness in area would have been a case too]

If Pain is Nociceptive:

If Pain Is Neuropathic:

  • neurectomy nerve ilioinguinal and iliohypogastric
  • proximal stumps are redirected and buried in the internal oblique muscle to prevent the later development of painful neuromas.
  • “Resection systematic genital branch of genitofemoral nerve, advocated by some authors, remains controversial. Indeed, this nerve is small and travels near the spermatic vessels.” Wound issues may arise and it is not worth it -  given it is not been proven to be the genesis of pain.  “The revision surgery with neurectomy provides relief of pain symptoms in 90% of cases.” – they referenced 3 studies.
  • In a series of  Neurectomy studies,  60% – 100%  had good results.                                                                                    ||
    \/

Another study:
Madura 2005 – Total pain relief was attained in 72% of patients, partial relief in 25%, and no relief in 3%.

Within next year or so should come out a study comparing injection therapy and neurectomy for post hernia pain – I may give more guidance:
ernia. 2010 Jul 17. [Epub ahead of print]
A randomised controlled trial of injection therapy versus neurectomy for post-herniorrhaphy inguinal neuralgia: rationale and study design.
Loos MJ, Verhagen T, Scheltinga MR, Roumen RM.   abstract here

Even newer techniques are coming online including:
spinal cord stimulation:
Spinal Cord Stimulation – Good Control of Post Hernia Pains

and peripheral field stimulation (only good if localized to one area):
mentioned here:
Post Hernia Surgery Pain Protocol and Other Options

Comment – It comes down to people having the appropriate nerve blocks; if qualify, having any necessary surgery; and if need be, having access to someone doing neurostimulation.

What experience have people had in this regard?

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5 Responses to Pain After Inguinal Hernia Repair – What to Do

  1. william says:

    Good information people who have the surgery will have different experiences some has to do with not rehab recovery time correctly, some doctor rushing them back to work too soon and some from just bad surgery.

  2. Jack says:

    Below is a link to a Saudi study on a new surgical technique. This study reports zero groin pain and no recurrence when this technique is used.

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2702909/

    FYI I found this study by putting the following into google:

    “inguinal hernia” “suture removal”

    Zero recurrence and zero groin pain – can’t get much better than that. I hope this is helpful and promotes some productive discussion. It seems that we should be using this in the United States.

  3. Jack says:

    anotehr reference:
    Saudi J Gastroenterol. 2008 July; 14(3): 122–127.

    doi: 10.4103/1319-3767.41730

  4. Shivereymetimbers says:

    It has been 17 months since my hernia surgery done with mesh and still have pain, a nerve blocker for pain have been done with no relief any advise that can be given to me, I don’t want to go through the rest of my life with this or how long do I have to suffer.
    How about a steriod injection would this help?
    ————

    steroid injections in posthernia surgery cases has only been recently investigated – but not reported – I have written the researcher and asked for comments.
    admin

  5. S-tar says:

    I had a double ingurnial hernia op nearly 4 years ago. . I had instant agony from the left side. No one really listened to me. 12 months on I had a hernia gram and a steroid injection which made it all worse. After. 15 months of agony., they opened me up to find the mesh had popped. Although, they re stitched the mesh in, I’m still in lots of pain. 3 years after the original op, I had a 3rd operation. (Keyhole for the first time) to look at what’s happening. I also had something called the lloyd release procedure. (Check it out). For 4 weeks I was almost pain free and all the bowel symptoms I was having settled down. But sadly, 3 months on and I’m back to square one again? I had a steroid injection a week ago and it actually feels worse now. When will this misery ever end? Will it ever end?

    I’m happy to find this page. Although, it’s a horrible situation lots of us have found ourselves in, I feel slightly better knowing I’m not alone.

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