Persistent pain after hernia surgery is said to occur between 6-10% of cases.
I am interested in trying to solve the troublesome problem of persistent pain after hernia surgery. Complications, recurrence and long-term pain can occur in some percentage after all methods. Long term pain can interfere with daily habits, work, sleep, exercise and require analgesics and their side effects. Then follows a cascade of problems related to persistent sedentary habits, weight gain, stress, occupational difficulties, muscle loss, sexual participation, home maintenance and depression.
All established primary care practices have referred patients for treatment of primary groin hernia. Patients and many primary care physicians consider primary hernia surgery as a routine commodity and the choice of surgeon is frequently determined by fee and practice routine. Sophisticated Internists know that a percentage of these operations have less than desirable results. These patients and their physicians become frustrated by rationalizations, ruminations, avoidance by consultants or inability and fear to reoperate on this challenging problem. This is understandable since reoperation is complicated, time consuming, and involves risks of complications and disappointment. The surgery requires knowledge of all of pitfalls of the varied types of primary repair and facility with various methods to remedy the problem.
Decision making also involves extended and empathetic consultations, patient education, studies, therapeutic tests and reasonable recommendations and explanations including candid expectations. Diagnostic nerve blocks are useful in some cases. Repeated interventions decrease the chance of success and increase the difficulty in reoperation.
Treatment options depend on diagnosis and the previous method of surgery, and include Open and Laparoscopic approaches, removal of mesh and plugs that requires tenacious mobilization of critical structures, neurectomy by laparoscopic or open approaches, revision or replacement of previous repair. Decades of experience with open and advanced laparoscopic methods, with and without mesh enable an aggressive approach to solving the problem if, and only if, the patient and I agree that the procedure is worth the risk and benefit and the symptom or finding MUST be eliminated.
DISCUSSION OF MANAGEMENT FOLLOWS...