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…
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regimen to prevent constipation and bloating may also be helpful. It is
often helpful to provide the patient with a multitude of pain medication
options and then allow them to choose which works best for them, as
they may already know from previous experience. Pain control in the
immediate postoperative period is essential, as some studies have shown
an increased risk for developing chronic pain in patients whose postoperative
pain scores are high. Perioperative multimodal pain management
inducing transversus abdominis plane (TAP) block and intra-op block
with long-acting local anesthetic may help to minimize pain control
issues in the immediate postoperative period.
Some patients will have continued difficulty with pain control following
surgery, especially if they were taking high doses of opioid medications
prior to the operation. All of the pain management techniques
previously discussed can be considered for use in the postoperative
course. Typically, as the pain and inflammation from the operation
resolve, the patient will become increasingly aware of the results from
the operation and will report that their improvement levels off 2–4
months after the operation. Following surgery, it is important to track a
patient’s progress for improvement. It may help to compare a patient’s
preoperative assessment of pain on a standardized questionnaire to their
postoperative pain to examine for objective changes.
Postoperative Complications
In the early postoperative period, complications include wound
infection, seroma, and hematoma. As mentioned, postoperative pain
control may be difficult.
The long- term complications pertinent to this procedure include
hernia recurrence and inadequate resolution of pain. Nonsurgical pain
management should be continued and adjusted accordingly for pain that
is not resolved in an attempt to improve a patient’s quality of life. A
continued search for factors that contribute to the development of
chronic groin pain after inguinal hernia repair is essential to predict
subpopulations at risk for this problem and to potentially alter treatment
options based on new knowledge when the concept of predictive analytics
and complex systems data management is applied [see Chap. 45 ,
“Value-Based Clinical Quality Improvement (CQI) for Chronic Groin
Pain after Inguinal Hernia Repair”].