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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S. Towfigh
periphery. He is 2+ tender along the entire groin area, nonspecifically.
There is no palpable mass or hernia recurrence. He has no hypesthesia
or allodynia in the region.
Imaging
Computed tomography scan performed 2 months postoperatively
demonstrated a n intact repair without hernia recurrence. There were
marked edematous changes without fluid collection.
Diagnosis
The patient was diagnosed with postoperative pain from anterior tissue
repair, without evidence of neuropathy. He also had no evidence of
spermatic cord injury, which can also at times be seen with this repair.
His symptoms of increased pain and swelling are concerning for tearing
of the repair, with associated edema and pain. As this is a tension repair,
and the patient notably is an elderly male with a relatively large hernia,
it is possible that the Shouldice repair was too tight and his tissue is not
supportive of such a repair. There is no evidence of infection or hernia
recurrence at this time, so conservative management alone is indicated.
Nonoperative Management Options
To address his inflammatory state and possible underlying tissue
tearing from a tight repair, the patient was recommended to begin local
treatment with ice as well as systemic treatment with nonsteroidal antiinflammatory
drugs (NSAIDs). He was also educated to rest the groin,
similar to treatment for a sports hernia, until the area is healed. Once
healed, he should begin a physical therapy regimen to regain abdominal
core muscle strength and mobility at his hip joint.
Operative Treatment
If the patient does indeed prove to have a hernia recurrence in the
future, then he is eligible for repair, which I recommend be performed
with mesh. The patient initially did not wish to have mesh repair, as he
was concerned about the risk for postoperative groin pain.