Chronic Pain after Inguinal Hernia Repair

Chronic pain, as it relates to a hernia repair, is defined as the presence of persistent pain at six months or longer after the initial hernia surgery. It is not a common complication of hernia repair. Many studies have tried to pinpoint the incidence of chronic pain after hernia repair, but these rates vary widely. One reason for this is that every patient has a different threshold for pain. Also, it is often difficult to determine whether the source of pain is directly related to the hernia repair or caused by a pre-existing condition.

Causes of Chronic Pain after a Hernia Repair

While there is much debate over the true cause of chronic pain, we can presume that the main causes and risk factors of chronic pain after a hernia repair are:

1. Irritation of nerves and tissue due to the hernia mesh. You may also learn more about biologic or absorbable mesh
2. If and how the mesh is fixated to the abdominal wall
3. A patient’s degree of pre-operative pain
4. An actual injury to one of the nerves in the groin
5. A patient’s age. The incidence of chronic pain is often lower as the patient gets older
6. The type of procedure – open surgeries have a greater chance of chronic pain than those performed laparoscopically.

Minimizing Chronic Pain Issues

While it is not possible to completely eliminate the chance of chronic pain after surgery, Dr. Lublin employs the latest techniques to minimize its occurrence.

There is no question that an inguinal hernia surgery performed laparoscopically or robotically has a much lower incidence of chronic pain than an open or traditional repair. This has been repeatedly proven in many academic studies.

The reasons for this are:

1. The surgery is all performed bluntly – meaning there is no division of any structures so there is no chance of injuring a nerve
2. The mesh used in a laparoscopic or a robotic hernia repair does not get tacked or sewn into place. When tacking a mesh or sewing a mesh in place, nerves can be entrapped in the stitches or nerves can be tacked. This can lead to pain. When mesh is placed in a laparoscopic or robotic repair, it is a self-fixating mesh. One side of the mesh has a Velcro-like coating so it sticks to the tissue without needing to be sutured or tacked.
3. The mesh used laparoscopic or robotic repair is also a single thin sheet. It won’t ball or roll up and, thus, incorporate itself into nearby nerves.

Dr. Lublin also strives to perform all his inguinal hernia procedures in a laparoscopic or minimally invasive manner. By accessing the hernia using three tiny incisions and using precise blunt dissection, versus a larger single incision using instruments requiring division of structures, the incidence of chronic pain after the procedure is reduced significantly.

Finally, surgeon experience plays an important role in minimizing complications including chronic pain. Because of Dr. Lublin’s significant hernia repair experience (over 1000 laparoscopic inguinal hernias repaired to date), he has had excellent results in minimizing the occurrence of chronic pain after surgery.