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

28. Prevention of Pain: Optimizing
the Open Primary Inguinal Hernia
Repair Technique
Giampiero Campanelli , Marta Cavalli , Piero Bruni ,
Andrea Morlacchi , and Gianni Maria Pavoni
The prevention of pain requires that surgeons should take care not
only during the entire surgical procedure but also before and after.
This chapter will provide some suggestions based on our experience
and up-to-date results from the literature for each of the following steps:
1. Preoperative patient selection
2. Selection of anesthesia
3. Choice of the approach: open anterior versus open
preperitoneal
4. Identification and respect of the three nerves
5. Choice of the prosthesis: plug, mesh, lightweight versus heavyweight,
absorbable versus nonabsorbable
6. Choice of fixation
7. Administration of a proper postoperative therapy
Preoperative Patient Selection
Sometimes a patient will complain of apparently inexplicable postoperative
pain, even if he has been treated in the same manner as other
patients reporting no postoperative pain. Do all patients have the same
risk to develop postoperative pain? Aasvang et al. [ 1 ] designed a novel
prospective study that had the primary end point of assessing the relative
contribution of preoperative, intraoperative, and postoperative factors in
the development of persistent postoperative pain (PPP) substantially
© 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_28
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