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

23. Mesh Removal for Chronic Pain:
A Review of Laparoscopic and Open
Techniques
Lisa A. Cunningham and Bruce Ramshaw
Introduction
The incidence of chronic pain or discomfort after inguinal hernia
repair is much higher than previously thought, and studies suggest it
could be higher than 50 %. Although most of these patients have mild to
moderate pain, in a review by Bay-Nielsen et al., the rate of chronic pain
after repair that interfered with work or leisure activity was determined
to be 11 %, which has the potential to affect many individuals, as there
are approximately 800,000 repairs performed each year in the United
States [ 1 , 2 ]. Regardless of the actual incidence, awareness of this problem
is increasing in surgeons and other physicians caring for such
patients, some of whom are desperate for help.
Fortunately, the vast majority of patients who experience chronic
pain symptoms after hernia repair have mild to moderate symptoms and
do not require invasive intervention to maintain a good quality of life.
For patients in whom chronic pain negatively affects their quality of life,
it can threaten the ability to function independently and to work for a
living. This degree of chronic pain can also have detrimental effects on
family and social relationships. It is not uncommon for some patients
with severe chronic pain to verbalize a willingness to commit suicide if
their pain cannot be relieved.
Chronic groin pain after hernia repair is a complex problem involving
many variables, making it difficult to fully understand and treat.
Chronic pain in this patient population can be a result of patient factors,
other diagnoses besides inguinal hernia, the surgical technique and
quality of the repair, the mesh and fixation materials used, and even the
© Springer International Publishing Switzerland 2016
B.P. Jacob et al. (eds.), The SAGES Manual of Groin Pain,
DOI 10.1007/978-3-319-21587-7_23
301