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

38. Patient with Groin Pain After Open
Inguinal Hernia Repair with Mesh
Jeffrey A. Blatnik and Ajita S. Prabhu
Chief Complaint
Right lower quadrant pain, status post six prior hernia repairs
History
The patient is a 51-year- old thin male with multiple prior inguinal
hernia operations with right lower quadrant abdominal pain described as
“burning” and at times “stabbing” and “dull.” Previously, he has had six
hernia operations on the same side. It began with an open inguinal hernia
repair with mesh at age 20 years to address preoperative groin pain radiating
to his right leg, across his back, and down to his groin area.
Approximately 2 years later, he developed stabbing pain in the same
location upon routine lifting of objects that he did not consider to be
heavy. He underwent a second open repair with mesh at that time and is
uncertain as to whether his first mesh was removed. He again had resolution
of his symptoms until 2 years later, when he had recurrence of the
same symptoms and underwent a third open exploration. He is unsure as
to whether mesh was placed at that time. Approximately 1 year afterward,
he developed an acutely incarcerated right inguinal hernia with obstructive
symptoms. He was taken emergently for a fourth operation and does
not know if mesh was placed at that time. Due to the time period during
which these operations took place, operative reports were not available
for review. Three years later in 2010, the patient developed recurrent pain
radiating to his right leg, groin, and back. He had his fifth exploration via
an open incision. At that operation, he was noted to have an onlay polypropylene
flat mesh on top of the external oblique aponeurosis, as well as
© 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_38
467