While no surgery is routine, an inguinal hernia repair is one of the more common and successful general surgeries performed in the United States, with approximately 800,000 procedures done each year. While the majority of patients do well and have a relatively uneventful recovery, a small percentage (up to 15% depending on the technique used) can develop chronic groin pain.
At Surgical Associates of North Texas, Dr. Scott deVilleneuve and our team pride ourselves on using the most advanced techniques to perform inguinal hernia repairs, including laparoscopic techniques for all of our inguinal repairs. Our goal is to ensure that each of our patients benefits from our experienced and comprehensive care from start to finish.
Most of our patients come through the surgery with flying colors, but a small number do experience lingering groin pain. Here’s a look at why this happens and, more importantly, what we can do about it.
All of our inguinal hernias are repaired using a laparoscopic, or minimally invasive technique. This will always utilize a synthetic mesh to cover the defect in your tissue where the hernia is located. This not only provides immediate repair of the hernia but also functions to cut down on the chance that it could recur in the future. In our practice, this recurrence rate has been less than .05% over that past 15 years of doing this procedure.
Along with a low recurrence rate, out techniques also allow for rapid, usually pain free recovery. Again, having collected data on this procedure for the past 15 years, we have around a 1% incidence of chronic pain after surgery, with most of those cases having been successfully treated with medical and minimally invasive methods.
When we perform a surgical procedure, even using the latest laparoscopic techniques, we’re still invading your body — and we’re also placing something foreign in it when we use a mesh. There are two main reasons why you may experience postoperative groin pain, and the first has to do with this mesh.
Some people’s bodies react poorly to the addition of the mesh, responding with inflammation that can irritate the nerves in the area. Think of it much like allergies — while most everyone can enjoy seafood without incident, a select few react badly, generating an immune response.
The second problem is that your abdomen contains important nerve conduits — three to be exact — and if the surgery or the mesh interferes with these nerves, it can lead to chronic groin pain. Even laparoscopic surgery runs the risk of encountering these nerves, and, while we make every effort to work around them, in rare cases the nerves can be irritated by the mesh or by the surgery itself.
If you’re still experiencing groin pain after your hernia repair, we perform a thorough review of your repair to locate the source of the problem. If we find nerve involvement, we always start out conservatively with medications aimed to to control your pain and to alleviate the cause, usually some sort of inflammatory process. If this isn’t successful, then we will turn to simple injections in the area of the involved nerve, usually consisting of local anesthetics (lidocaine, marcaine) mixed in with a small amount of steroids. If this works, then usually nothing else is needed. If not, then we will have you consult with one of the pain management specialists that we work with to try a more potent, longer acting anesthetic agent. In almost all cases, this eventually works and will get patients back to a level of activity and comfort that they are happy with.
Looking up these symptoms on the internet you will find people discussing and advocating for removing the mesh. Don’t ever let anyone use this as a first line option, as the process of removing a previously implanted mesh will usually cause more harm than just leaving it, and can often leave people with permanent disabilities. There is very little that can be accomplished by removing the mesh that can’t also be accomplished by a skilled pain management doctor. I will say that I’ve only had to do this once in fifteen years of hernia repairs, and as anticipated the removal of mesh did not do anything to help the pain that was being experienced. As such, I don’t recommend this hardly ever.
If you have more questions about groin pain after a hernia repair, please don’t hesitate to give us a call. Or you can use the online scheduling tool to set up an appointment.