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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N.F. Stoikes et al.
However, the clinical data are not consistent and do not seem to correspond
with the objective findings found in the basic science. Overall,
autogenous and mesh repairs have been found to have similar outcomes
of CGP. Further complicating the landscape are the different outcomes
found with different techniques of either autogenous or mesh repairs. It
has been suggested that there is more CGP with the McVay repair compared
to the Shouldice repair [ 4 ]. There are the same issues found with
mesh repairs. Whether it is laparoscopic versus open, or fixation with
fibrin glue, tacks, or sutures, they have all been evaluated and found to
have different outcomes independent of the mesh. In fact, studies have
supported that the laparoscopic approach appears to have the best results
out of all autogenous and mesh repairs combined. Given this, mesh is
clearly not the sole cause of CGP in inguinal hernia repair.
CGP is a multifactorial process that is influenced by the innate complexity
of groin anatomy, psychosocial issues, and various technique
options requiring different anatomic knowledge for each approach. In
spite of the difference of opinion between Fischer and Gilbert, they both
indicated in their commentaries that the performance of excellent surgical
technique—regardless of actual technique choice—was one of the
most important factors in preventing CGP [ 4 , 5 ]. Therefore, the best
approach for an inguinal hernia repair lies in the hands of the surgeon to
select a technique in which the surgeon has complete knowledge of all
the potential technical pitfalls and is the most comfortable performing.
References
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The effect of polypropylene mesh on ilioinguinal nerve in open mesh repair of groin
hernia. J Res Surg. 2006;131(2):175–81.
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