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

32. Chronic Groin Pain:
Mesh or No Mesh
Nathaniel F. Stoikes , David Webb , and Guy R. Voeller
Introduction
Inguinal hernia repair techniques have evolved over time. In the days
when tissue repairs were more prevalent, recurrence rates were as high
as the 10–20 % range. For this reason, the primary outcome of importance
was reduction of recurrence. Now that mesh-based repairs of
inguinal hernias have reduced recurrence rates, the outcome of postoperative
chronic groin pain (CGP) has gained importance. The concern
for postoperative CGP has increased in direct correlation with the
increased use of synthetic mesh for inguinal hernia repair; thus, many
have thought the relationship was a causal one.
However, there are a multitude of risk factors and variables that influence
CGP after inguinal hernia repair. The exact role that mesh and its various
forms of fixation play in the development of postoperative CGP remains to
be determined. In addition, it remains unclear whether the incidence of CGP
has actually increased due to the use of mesh for inguinal hernia repairs. It
may be that groin pain had been an issue with tissue repairs and it was overlooked
due to the main focus on recurrence as an outcome measure.
It is the focus of this chapter to specifically evaluate not only the
objective data but also the perceptions surrounding the role that synthetic
mesh may play related to inguinal hernia repair and postoperative CGP.
Risk Factors
Regardless of the use of mesh, there are many factors that affect the
risk of development of CGP in inguinal hernia repair. The presence of
preoperative pain, psychosocial issues, and aberrant nerve anatomy can
© 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_32
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