ZenToks Publication

Chapter 21

Chronic Pain following Inguinal Hernia Repair: A Review

Abstract/Preface

Chronic pain represents a significant long-term complication following inguinal hernia repair and has increasingly been recognized as a major outcome measure alongside recurrence rates. It is typically defined as pain persisting for a minimum of three months post surgery. The severity of chronic pain can vary from mild discomfort to severe, debilitating pain that negatively impacts quality of life, daily activities, and employment. The etiology is multifactorial, encompassing neuropathic injury to the ilioinguinal, iliohypogastric, and genital branches of the genitofemoral nerves, as well as mesh-related inflammation, fibrosis, mesh contraction, and periosteal injury. Identified risk factors include younger age, female sex, preoperative pain, severe early postoperative pain, recurrent hernia repair, and the use of open mesh techniques. Diagnosis necessitates a thorough clinical assessment to distinguish between neuropathic and non neuropathic mechanisms. Management follows a stepwise approach, ranging from pharmacological therapy and nerve blocks to neurectomy and mesh removal in selected cases. This chapter provides a summary of the incidence, risk factors, prevention, and treatment of chronic pain following inguinal hernia repair in adults.