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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J.A. Blatnik and A.S. Prabhu
a polypropylene flat mesh on the floor of the inguinal canal, with a small
direct hernia recurrence. This was repaired primarily with permanent
suture. The onlay mesh over the external oblique aponeurosis was
resected, and the mesh on the floor of the canal was left in place. Finally,
in 2011 he had painful recurrence of his symptoms and was taken for
open right inguinal exploration with resection of all previously placed
mesh and permanent suture. The ilioinguinal nerve was not seen or identified.
Notably, there was no hernia identified at the time of that operation
and therefore no new sutures were placed. This operation was complicated
by an immediate postoperative expanding hematoma for which he
was emergently explored. He had a brief reprieve from his pain postoperatively.
He presented 2 years later with recurrence of his symptoms.
Physical Exam
He had multiple surgical scars in the right lower quadrant, a small
recurrence of his hernia, and palpable mesh in the subcutaneous space with
tenderness over the area. There was no hypesthesia or allodynia noted.
Imaging
Computed tomography scan of the abdomen and pelvis was obtained
that did not show an obvious recurrence.
Nonoperative Management Options
As part of the workup for this problem, the patient was referred to a
pain management specialist who performed a comprehensive neurologic
exam. He did not feel that the pain was neuropathic in nature. The
patient was offered a transcutaneous electrical nerve stimulation unit as
a noninvasive measure for pain control. The patient did not pursue this
due to the cost and also the desire for a more definitive cure for his pain.
Diagnosis
The patient was considered to have a hernia recurrence (most likely,
again,) of his direct hernia. In addition, it was unclear if the mesh alone
was contributing to his symptoms. We did not feel that he suffered from