Patients may be unable to work, have limited physical & social activities, sleep disturbances, and psychologic distress.
The management of inguinodynia is a difficult problem for many surgeons and 5–7% of patients experiencing post-hernia repair groin pain litigate.
[7] Method of fixation has also been hotly debated with varying results reported with few consistent findings of decreased long term groin pain.
[12] Unless there is evidence of a recurrence, operative intervention should be deferred for at least 1 year since groin pain decreases with time elapsed from surgery.
[citation needed] If operative repair is chosen, mesh excision +/- triple neurectomy may be considered with small studies suggesting good outcomes.
[17] However, standard triple neurectomy does not address inguinodynia secondary to neuropathy of the genitofemoral nerve and the preperitoneal segment of its genital branch.
But extension of the standard triple neurectomy to include the genitofemoral nerve has given good results, on a small series of 16 patients.
Other algorithms proposed have included diagnostic laparoscopy at the start for evaluation of adhesions, removal of mesh, and repair of any recurrences.
[citation needed] Chronic groin pain is more common than recurrence, and it may be lower following laparoscopic hernia repair.
In addition, when an inguinal pain questionnaire was administered to these individuals at a median followup of 9.4 years, physical ability was affected more in the open repair group.
Predictors of chronic pain in the TEP group included Body Mass Index ≤ 3rd quartile (OR: 3.04), difference in preop and postop physical testing (OR: 2.14) and time to full recovery exceeding the median (OR: 2.09).
[23] The experience of the surgeon critically impacts the results, especially for Shouldice and laparoscopic repairs, which are fairly technical operations.