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  • Writer's pictureDr Vishal Soni

Post-Hernia Surgery Inguinodynia

Understanding and Managing Post-Hernia Surgery Inguinodynia: A Surgeon's Perspective


Dermatomal Mapping in case of Chronic Inguinodynia
Chronic Inguinodynia

Introduction:

Hernia surgery is a common procedure performed worldwide to repair a protrusion of an organ or tissue through a weak spot in the abdominal wall. While modern techniques have significantly improved outcomes and reduced complications, some patients may experience persistent groin pain after surgery, a condition known as inguinodynia. As a seasoned hernia surgeon, I understand the challenges and concerns associated with this postoperative complication. In this blog, I aim to shed light on inguinodynia, its causes, symptoms, diagnosis, and management strategies.


What is Inguinodynia?

Inguinodynia refers to chronic groin pain that persists after hernia repair surgery. It can manifest as dull, aching discomfort, sharp stabbing pain, or burning sensations in the groin area. This condition can significantly impact a patient's quality of life, limiting mobility, and causing emotional distress.


Causes:

Several factors can contribute to the development of inguinodynia following hernia surgery:

1. Nerve Injury: Damage to the ilioinguinal, iliohypogastric, or genitofemoral nerves during surgery can lead to neuropathic pain.

2. Scar Tissue Formation: Excessive scar tissue (adhesions) at the surgical site may entrap nerves or cause tension, resulting in pain.

3. Mesh-related Issues: In some cases, the type or placement of mesh used in the hernia repair can lead to chronic pain.

4. Muscular Imbalance: Alterations in muscle function or imbalance due to surgery may contribute to discomfort.


Symptoms:

The symptoms of inguinodynia vary from patient to patient but commonly include:

- Persistent groin or testicular pain

- Discomfort exacerbated by physical activity, coughing, or straining

- Numbness or tingling sensations in the groin area

- Pain radiating to the thigh or abdomen


Diagnosis:

Diagnosing inguinodynia requires a comprehensive evaluation, including:

1. Patient History: Detailed assessment of the patient's symptoms, surgical history, and any previous treatments.

2. Physical Examination: Palpation of the surgical site to identify areas of tenderness or scar tissue.

3. Imaging Studies: MRI or ultrasound may be used to visualize the anatomy and assess for nerve entrapment or mesh-related issues.

4. Nerve Blocks: Diagnostic nerve blocks can help localize the source of pain and guide treatment decisions.


Management Strategies:

Managing inguinodynia requires a multidisciplinary approach tailored to each patient's needs. Treatment options may include:

1. Conservative Measures:

- Pain Medications: Non-steroidal anti-inflammatory drugs (NSAIDs) or neuropathic pain medications may provide relief.

- Physical Therapy: Rehabilitation exercises to improve muscle strength, flexibility, and posture.

- Nerve Blocks: Injection of local anesthetic or steroids to alleviate pain and inflammation.

2. Surgical Interventions:

- Mesh Removal: In cases where the mesh is implicated in pain, surgical revision or removal may be necessary.

- Nerve Decompression: Surgical release of entrapped nerves or neurectomy (nerve removal) may be considered.

3. Psychological Support: Chronic pain can have a significant psychological impact, and counseling or pain management programs can help patients cope and improve their quality of life.


Robotic Triple Neurectomy showing Genito-femoral nerve
Robotic Triple Neurectomy

Inguinodynia is a challenging complication of hernia surgery that requires careful evaluation and management. As a hernia surgeon, my goal is to alleviate my patients' suffering and improve their quality of life through a comprehensive approach that addresses the underlying causes of pain. By understanding the complexities of inguinodynia and offering personalized treatment strategies, we can empower patients to overcome this challenging condition and regain their health and well-being.


Dr Soni is an expert Robotic Hernia Surgeon. If you have symptoms of chronic inguinodynia, consult Dr Soni at The Hernia Clinic - Zydus Hospitals, Ahmedabad, Gujarat, Bharat.

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