Brian P. Jacob, David C. Chen, Bruce Ramshaw, Shirin Towfigh (eds.) - The SAGES Manual of Groin Pain-Springer International Publishing (2016)

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E.L. Felix
Fig. 16.2. Lateral fold-up of mesh with an indirect recurrent hernia in a patient
with groin pain.
mesh rolled up or folded in on itself, it should be removed. Pressure on
sensory nerves from hardened mesh can result in chronic groin pain,
especially related to activity and change in position. Removal, however,
can be difficult. In some cases, the careful use of cautery is required to
cut the mesh away from the wall. A careful search for recurrence of the
original hernia or a missed hernia completes the exploration (Fig. 16.3 ).
It is not unusual to find a defect that was missed by preoperative radiographic
studies. If a recurrence is found to be the cause, it should be
repaired with the addition of new mesh. If recurrence is associated with
bunched-up, hardened mesh (Fig. 16.4 ), the surgeon should consider
removing the mesh and delaying repair of the recurrence. A recurrent
hernia can be repaired from an anterior approach after the patient recovers
from the laparoscopic exploration. This staged approach better
defines the etiology of the pain and leads to fewer long-term problems
and less confusion.
“When should all of the mesh be removed?” is a frequently asked
question. There are those who believe it is best to remove all of the mesh
[ 29 ]. This has not been our approach. Unless the mesh has hardened into
a rock-like mass that is potentially irritating or compressing a nerve, it
has been our approach to leave it in place. The risk of damaging surrounding
structures by unnecessarily removing mesh far outweighs any
potential benefit .