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H E R N I A
R E P A I R
Discomfort after hernia surgery is expected. But when the
pain persists past 30 days, it becomes a source of dismay for patients and frustration for surgeons, who are
often unaware of the scope of the issue. There are
upwards of 1 million hernia repairs done each year. If an
estimated 15% to 35% of those patients experience post-op chronic
pain, hundreds of thousands of individuals are in discomfort following
surgery. But understanding the many factors that contribute to the
problem can prevent it from happening in the first place.
• Patients. Experts agree that laparoscopic repair is best for
patients with previous complicated open mesh repairs or bilateral
hernias. Research has shown that male patients younger than 40
years old who show pain symptoms out of proportion with pre-op
physical exams typically don't do well with mesh repair. Additionally,
patients undergoing recurrent hernia repair and patients who experience high levels of pre-op pain are more likely to suffer from post-op
chronic pain.
• Technique. Very few surgeons are attentive to avoiding hernia
surgery's "blue line" — the internal spermatic vein and the genital
branch of the genitofemoral nerve — that leads to the significant
number of patients who suffer post-op chronic pain.
Most chronic pain occurs after open surgery dissection that
requires surgeons to carefully move tissue and the spermatic cord.
They show varying attention to detail in identifying the 3 sensory
nerves found in the groin: the ilioinguinal, genito-femoral and iliohypogastric. Exaggerated scarification responses or the surgeon's lack
of meticulous dissection while operating (injuring the nerves with
suture or compressing them with mesh) can damage one or more of
these nerves.
