Inguinal Pain After Hernia Surgery

This is a very good article on a very successful surgery for Inguinal pain after Hernia repair that does not respond to conservative measures.

PLEASE SEE OTHER SECTION ABOVE, TITLED : JERRY HESCH'S NEW INGUINAL NEUROPATHY TEST

What is missing from many published works is how very devstating this kind of a pain syndrome can be. Can you imagine having the inguinal ligament pinched with a pair of pliers constantly? These clients have a very difficult time finding a comfortable position. In males, pain along the spermatic cord and testicle is not uncommon. Females have a much narrower and therefore stronger inguinal canal, and therefore have much fewer surgeries. Those who do have similar neuropathies do indeed suffer perhaps equally.




New Understanding of the Causes and Surgical Treatment of Postherniorrhaphy Inguinodynia and Orchalgia 
Parviz K Amid, MD, FACS, Jonathan R Hiatt, MD, FACS. J Am Coll Surg Vol. 205, No. 2, August 2007

Although advances in inguinal hernia repair have markedly reduced the postherniorrhaphy recurrence rate, chronic pain after hernia repair is of continuing concern.According to the Swedish hernia registry, the incidence of chronic postherniorrhaphy pain is greater than that of hernia recurrence.1The ilioinguinal, iliohypogastric, and inguinal segment of the genital branch of the genitofemoral nerves are vulnerable to injury and, when injured, can produce pain syndromes that are refractory to narcotics and multidisciplinary management techniques. Earlier reports by us and other authors have described the causes, prevention, and surgical treatment of postherniorrhaphy chronic pain.2-4e have emphasized key features of groin neuroanatomy and demonstrated the effectiveness of a one-stage procedure for management of postherniorrhaphy neuropathic inguinodynia that combines resection of the ilioinguinal, iliohypogastric, and genital nerves through an inguinal approach.4,5 We also have identified “meshoma” as a radiologic entity and pathologic cause of chronic pain.6 Meshoma occurs when the mesh prosthesis becomes wadded into a ball because of nonfixation, insufficient fixation, or insufficient dissection to make adequate room for the prosthesis. Our series now stands at 415 patients who have undergone operation for chronic postherniorrhaphy groin pain. Recent observations of groin neuroanatomy and additional experience with meshomas have prompted a modification of our neurectomy technique to include a more extensive resection of the iliohypogastric nerve and, for patients with orchalgia, nerves within the lamina propria of the vas deferens as well. These observations also illustrate methods to avoid nerve injuries at the primary operation.