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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