Postinguinal Herniorrhaphy Pain

Abstract

The evaluation of postinguinal herniorrhaphy pain and its natural history has been sidetracked by the study of other postoperative problems such as recurrence, infection, testicular ischemia, and so on. Disabling inguinodynia constitutes a difficult to treat complication that may lead to disability and legal and laboral litigation. Dr Nienhuijs and colleagues are to be commended as they try to delineate and clarify the natural history of this complication. But a disquieting aspect of their work is their incidence of significant and chronic pain. Of 297 studied patients, 68 developed moderate but chronic pain, and in 20, the pain not only was chronic but severe, totaling a 29% incidence of significant inguinodynia. In our service, we follow the policy recommended by Wantz of cutting any nerve branch that may interfere with the repair, avoiding unnecessary nerve manipulation, and paying attention not to include nerve branches within suture lines. Following this policy, we have not had a single case of postoperative inguinodynia in 4,029 consecutive inguinal herniorrhaphies performed since 1981 using a variety of anatomic or tension-free repair techniques. To better prepare our patients for the unavoidable postoperative discomfort, they are preoperatively informed to expect a moderate amount of incisional pain, which will diminish with time. We also stress that this discomfort could recur in unimportant form during laborious work or exercise. Postinguinal herniorrhaphy pain can be avoided by adhering to these steps.