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Chronic Pain Considerations After the Hernia Repair

Chronic pain after hernia surgery is defined as mild to significant pain occurring on a regular basis three months after the surgical procedure is performed. It represents the most common single risk post hernia repair surgery. It is estimated that between two and ten percent of all hernia patients will experience some form of chronic pain after surgery. However, most instances of chronic pain are mild and/or temporary. In many cases the pain resolves itself within a year after surgery. Persistent pain can most often be managed with conservative treatments.

What causes chronic pain after hernia surgery?

This topic is not very well understood. However, we can surmise that nerve involvement is the primary cause of chronic pain. The nerve can be irritated by the surgical procedure itself, or possibly by the mesh used to repair the hernia.

Some things to consider about chronic pain

Surgical Method / Technique

First, the surgical method employed plays a significant role in the incidence of chronic pain. Open surgery typically carries a greater risk of chronic pain than laparoscopic hernia repairs. This is because open surgery requires sharp cutting of tissue and therefore increases the risk of damage to the nerves in the area. Laparoscopic surgery employs blunt dissection and typically avoids many of the most sensitive nerves. Surgeon experience becomes paramount in this regard. We perform most of our surgeries in a laparoscopic manner and have consequently seen the risk of longer-term post-operative discomfort reduced significantly when compared to the open approach.

Mesh Considerations

Whether or not mesh used in the hernia repair causes chronic pain is still a topic being debated by the medical community. Each patient has a different sensitivity to foreign implants, and the reaction to the mesh can play a role in the amount of discomfort that patient will experience. This was a greater consideration in the past as thicker, less-advanced mesh materials often caused discomfort and excessive inflammation. Newer technologies, including thinner mesh materials, balance strength with reduced inflammatory response, in turn, reducing the incidence of mesh-related discomfort and complications significantly.

Affixing the Mesh

The tacks used to affix the mesh to the surrounding musculature can also play a role in pain after surgery. Whereas in past, permanent titanium tacks were often used, now we are often able to use absorbable tacks or sutures that dissolve by the time the repair has reached suitable strength. There are also new self-adhering meshes that require no fixation whatsoever. With modern fixation technology, this issue is less concerning than it once was.

Pre-operative Pain / Discomfort

Some studies have shown that patients with a significant degree of pain before the hernia repair tend to have a higher incidence of pain after the repair as well. Also, patients that do not manage their pain effectively in the immediate postoperative period may experience more chronic pain. To help avoid this issue, hernias should be repaired sooner rather than later and patients should be sure to employ proper pain management per their post-operative instructions.

This brings us to nerve pain in general. The surgeon’s experience and an anatomical knowledge of the affected area is key to ensuring the least possible nerve involvement. This means meticulously identifying nerves around the surgical field to make sure they are avoided. This knowledge is required both during dissection, and during placement of the mesh and tacks. Because no two patients have the exact same anatomical build, experience in this domain is imperative. Facilities and surgeons, like ours, that perform a significant number of hernia repairs every year are more likely to mitigate chronic pain issues.

Finally, it is important to remember that chronic pain figures do not account for emergency versus elective hernia repairs. Generally speaking, elective repairs have fewer complications, including a lower incidence of chronic pain after the procedure. This is one reason why healthy, symptomatic patients will almost always be indicated for surgery.

What to do in cases of chronic pain?

Chronic pain does not necessarily mean a lifetime of discomfort. In fact, most cases of chronic pain are very mild and may resolve spontaneously over the course of months or even a few years after surgery. For those cases that do not resolve in a reasonable amount of time, patients have several pain management options at their disposal.

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