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10.5005/jp-journals-10007-1099 WJOLS
REVIEW ARTICLE Inguinodynia after Laparoscopic Inguinal Hernia Repair
Inguinodynia after Laparoscopic Inguinal

Hernia Repair

Abdulkareem Aldoseri
Fayha General Hospital, Basra, Iraq

Abstract
Objectives: The objective of this literature review is to see if changing the site of the mesh from outside to inside has any effect on the
occurrence of posthernia repair pain. And also to review different author's opinion about causes occurrence and management of post-
mesh inguinal pain.
Materials and methods: Literature review conducted using Google search engine, Google books, HighWire press, using keywords like
postinguinal hernia pain, complications of hernia surgery, laparoscopic mesh repair.
Results: Chronic pain after surgery has been recently a neglected topic. The extent of the problem first came to light in a survey of
patients attending pain clinics in Scotland and the north of England. This survey showed that about 20% of patients attending chronic pain
1
clinics implicated surgery as one of the causes of their chronic pain, and in about half of these; it was the sole cause. Inguinal hernia
repair is a common surgical procedure performed worldwide with an annual procedural rate of 2,800 per million people in the United
States alone. In England and Wales, 70,322 primary inguinal herniorrhaphies were performed in National Health Service Hospitals
between 1998 and 1999. Inguinal herniorrhaphy is often performed as a daycase procedure with minimum postoperative morbidity. After
inguinal hernia repair, patients can return to work early and enjoy a good quality of life. Since modern surgical thinking concerning inguinal
hernia repair was established by Bassini in 1884, various modifications have been developed to improve outcome. Despite the fact that
recent meta-analyses have suggested that laparoscopic surgery is associated with less postoperative pain and more rapid return to
normal activity, open mesh repair is still recommended by the National Institute for Clinical Excellence.
Keywords: Inguinodynia, Laparoscopic, Inguinal hernia, Complication of Inguinal hernia.

CAUSES its genital branch and its femoral branch located in the parietal
compartment without protection from direct contact to the
There are many causes for the persistent, postoperative 2
hernia area pain including, but certainly not limited to: mesh.
• Nerve damage (directly at the time of surgery) Laparoscopy is no better than open surgery at reducing
• Nerve entrapment in scar tissue, mesh or sutures recurrence or chronic pain according to a meta-analysis by
• Postoperative benign nerve tumors British researchers. With laparoscopy, however, patients
• Scar tissue itself or tissue damage do have less postoperative pain and return to work more
• Misplaced mesh quickly, and although operating times are longer, patients
• Contracted, scarified and hardened mesh plugs have fewer superficial wound infections. Operating time
• Infection usually noted early postoperatively was significantly longer for laparoscopy (weighted mean
• Recurrent hernia. difference: 0.68 min), but return-to-work time was shorter
Constriction or narrowing of the internal inguinal ring (weighted mean difference: 0.82 days). 3
around the spermatic cord. Laparoscopic inguinal hernia repair, which requires the
Periostitis of pubic bone due to the presence of use of mesh, became popular because of a claimed reduction
permanent suture material inadvertently placed into this layer of postoperative pain and early return to normal activity.
resulting in chronic inflammation and pain. Liem et al described fewer recurrences and more rapid
Pain from unrelated causes associated with neither the recovery compared to conventional anterior repair. The EU
prior inguinal hernia nor its operative repair (i.e. nonhernia Hernia Trialists Collaboration included 34 (quasi-)
musculoskeletal, intra-abdominal, intrapelvic, neurologic, randomized trials in a systematic review. It was confirmed
genitourinary, infectious or vascular origin etc.). that laparoscopic repair of inguinal hernias results in less
Pain after placement of mesh in the parietal compartment recurrences when compared with open non-mesh repair.
of proportional space presents special problem, the main No difference was found between laparoscopic repair and
trunk of genitofemoral nerve, the preperitoneal segment of open mesh repair with regard to recurrences.

World Journal of Laparoscopic Surgery, September-December 2010;3(3):135-138 135