It's not a rare condition. It can occur in up to 20% of patients in the 1st year post intervention and can affect about in 10-12 % of patients two years after surgery. It's related to a nerve entrapment and is more present in techniques that require many stitches. In open surgery the pain is more frequent than in laparoscopic surgery, but this seems to be true only in the early post operative period. Anyway, in open surgery it represents the most important complication, much more than recurrences.

How to manage the post herniorrhaphy pain? If your patient suffers of a mild to moderate pain, you can treat him with GABA derivates like gabapentin or pregabalin, if your patient suffers of a severe pain that's still present one year after surgery you should consider the surgical revision with the goal to cut or coagulate the entrapped nerves. Is not so easy, good luck!. More easy seems to be the prophylaxis of the post herniorrhaphy pain. You have two ways: 1) research and rigorous respect of the three nerves, ilioinguinal, iliohypogastric and genitofemoral. 2) destroy with coagulation the ilioinguinal nerve and pay many attention to do not pose any stitch across the other two nervs.

Abstract

World J Surg. 2010 Apr;34(4):692-6. doi: 10.1007/s00268-010-0410-y.

The incidence and success of treatment for severe chronic groin pain after open, transabdominal preperitoneal, and totally extraperitoneal hernia repair.

Bright E1, Reddy VM, Wallace D, Garcea G, Dennison AR.

BACKGROUND:

Chronic groin pain (CGP) is a significant cause of postoperative morbidity after inguinal hernia repair. Open, transabdominal preperitoneal (TAPP), and totally extraperitoneal (TEP) repair are all commonly performed methods of herniorrhaphy. The aim of this study was to compare the frequency of attendance at a chronic pain clinic (CPC) for CGP after open, TAPP or TEP repair.

METHODS:

A retrospective review of all inguinal hernia repairs between January 1997 and December 2006 identified patients attending the CPC for CGP post-herniorrhaphy. In this study CGP post-herniorrhaphy was defined as pain that limited daily activities despite simple analgesia thereby requiring referral to the specialist CPC following surgical review.

RESULTS:

A total of 8513 patients underwent 9607 inguinal hernia repairs; 6497 (75.5%) were open, 1916 (22.3%) were TAPP, and 198 (2.3%) were TEP. Of these, 46 (0.71%) open, 22 (1.15%) TAPP, and 6 (3.03%) TEP repairs required attendance at CPC. A statistically significant difference in frequency of CPC attendance following laparoscopic versus open (P = 0.008), TEP versus open (P < or = 0.001), and TEP versus TAPP repair (P = 0.027) was observed. After an average of 1 year, 69% of patients were discharged symptom-free from the CPC. In 16%, CGP resolved prior to CPC attendance.

CONCLUSIONS:

In contrast to previous reports, laparoscopic hernia repair is associated with a greater frequency of attendance at CPC than open repair, a finding that merits further investigation. Of those requiring treatment, the majority were discharged pain-free after an average of 1 year

though the quoted incidence of post inguinal herniorrhaphy is around 10 to 20% ;however in our practice. Surprisingly enough I don't remember even a single patient who had been visiting us for pain only and there has never been a patients admitted for da same reason.curiously enough we often transect the nerves as we enter the inguinal canal.most of these open hernia repair pts turn back for a followup in the post discharge period for routine check up only.however the only significant complican that we get is of mesh infecn which in our settings is more cammon with laparoscopic repairs.

Dear Suvendu,

When I started my career in the 1980's, postoperative inguinalgia was never discussed, albeit it was for sure then much more frequent than today. The fact that your patients do not spontaneously inform you about postoperative discomfort, is definitely not proof that neither of them do experience it.

I suggest you start asking them about it...

There may be two main causes for the chronic groin pain after hernioplasty to persist:

1. The mesh malposition (coexisting usually with a large and intractable with conservative treatment seroma)

2. The 'trio' of the aforementioned nerves entrapment as a result of some erroneous stich made during the operation.

If we have deal with the latter case (2), the pain syndrome is acute, sharp, and clearly defined, binding with both the tenderness and the paraesthesia of the skin of the innervated area in every case. As a rule, those cases are so called 'difficult hernia', which have been multiply operated before. When doubtful, a neurologist should visit the patient not later than 3 post-operational days. The treatment of choice for the entrapment is the early re-surgery.

The entrapment of the main nerval trunks of the groin (nn.ilioinguinalis, iliohypogastricus, and ramus genitalis nervi genitofemoralis) seems to be a very rare complication, with incidence fewer than 1-2:1000 groin hernioplasties. The entrapment of their smaller branches is hardly to determine, the smaller, the more difficult.

There has been a similar topic already - will you see below, please?

https://www.researchgate.net/post/What_should_be_the_current_practice_concerning_nerve_s_management_during_open_inguinal_hernia_repair_preservation_or_neurectomy/1