Long term discomfort following the operation

So much has been written on this topic, which I agree is a major concern, but it is a pity that so much of it is misleading and simply wrong.   There is so much disinformation, muddled thinking and sheer scaremongering that it is doing a great disservice to an excellent operation. Excellent when correctly carried out.

Firstly – I don’t believe that mesh is a cause of pain when used appropriately. There are articles in the surgical literature documenting long term pain after inguinl hernia repair before the introduction and use of mesh.

So – why do people get prolonged pain or discomfort after inguinal hernia repairs? The short answer is we don’t know exactly. A slightly longer answer is that there are probably a number of different reasons.

People use phrases such as ‘trapped’ nerves, nerves caught in mesh, or blame the mesh itself. From my personal experience, personal observations and speaking with colleagues I believe that the main cause of long term post-op pain is poor surgery. Simple poor surgical technique.

Some patients I see will say that they read that long term pain occurs in 30% of inguinal hernia repairs. I find that statistic incredible. I would have given up, had to give up, hernia surgery long ago if that was the case. In reality I would say that I see prolonged discomfort in about 0.5% of the patients I operate on, and in my experience it resolves over time.

A second category or type of patient comes to see me after having been operated elsewhere. They have pain after their operation. But I don’t believe they had a hernia before their operation. They had another cause for their groin pain. Often they wlll say they never had a bulge or swelling before their operation, but the ultrasound scan showed one.

The problem is that ultrasound is a poor investigation for diagnosing inguinal hernias. It has unacceptably high rates of both false negatives (missing hernias that are there), or worse false positives (diagnosing hernias that aren’t there).

So these patients with pain, who blame the operation, never had a hernia in the first place but had another cause for groin pain. But the operation and mesh get blamed.

Elsewhere I will deal with treatment for this condition.