I have personal experience of this and find topical lidocaine patches very effective in suspected adhesion-associated pains

The incidence of recurrent paint after inguinal herniorrhaphy is rare. When the fibrosis develops after mesh repair or after nylon-darn technique the ilioinguinal nerve can be compressed by the fibrosis and cause pain. It is more common after mesh repair. Sometimes you need to give topical lidocaine patches which are often non helpful, then you need to reoperate the patient and do transection of the nerve.

I am absolutely agree  with Dr. Rosie and Mihailo. Also in my experience the firste step is local or regional injection of anahestetics (in some cases also TAPP block could be an option); if this approach is not totally curative the further option is surgery (nerve section or sometimes also mesh rremoving)

Fibrosis can cause pain but less common in open surgery.Initial treatment is anti inflammatory analgesics ,if not helpful Local nerve blocks will help.surgery is rarely indicated.

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Hello

If the patients continues with pain immediately after herniorraphy you must think in the spine as the cause for it, or a bad correction.

If the patient has a recurrence of the pain weeks or months after herniorraphy, there can be a hernial recurrence, or it is due to some effort or movement, or due to nerve entrapment. If it is a recurrence you must operat again. In cases of effort or nerve entrapment you can solve it with antiinflamatory drugs, lidocain or corticoid local injection, and rest.

In some cases of nerve entrapment all this measures do not work and prosthesis must be removed.

The most important to treat inguinal pain after hernia repair is clinical history and to understand the cause.

Best

I agree with Dr Almeida. Always have the spinal problem in mind. Non steroidal anti-inflammatory  medication is of great help. I have found injection of Triamcinalone with Bupivacaine is very helpful but only for trigger point tenderness, believed to be due to small neuromas or trapped nerve fibre. This is where I find LA repair is great because I make the patients cough after repair to test the repair, but if a stitch is close to or through a nerve fibre, patient has excruciating pain, allowing the surgeon to sort it out before closing the wound. Something we can't do when doing the operation under GA.

Chronic groin pain or severe post op pain is due to fibrosis following mesh repair. We will recommend mesh free and tension free open repair in all cases to avoid dangers of a foreign body. Pl. visit www.desarda.com

Try anti-inflammatory , local nerve blocks . If no effect remove the mesh and repair anatomically.

I am comparing pain scores postoperatively after desarda repair and lichtenstein mesh repair, my preliminary results show desarda repair has post op less pain.... still waiting for final results along with its statistical assessment