Laparoscopic treatment of chronic pain following inguinal hernia repair: a narrative review of the literature

Approximately 5% of patients undergoing open hernia repair, and probably less after laparoscopic repair, will suffer from severe disabling chronic pain. The optimal strategy for surgical treatment of chronic pain following inguinal hernia repair is debatable and not evidence-based. Laparoscopic removal of mesh and/or retroperitoneal neurectomies have been performed in attempts to treat patients with chronic pain after inguinal hernia repair. The aim of this qualitative review is to analyze the evidence surrounding a laparoscopic approach to the surgical management of chronic pain following inguinal hernia repair. Only prospective studies including at least 10 patients operated with a laparoscopic technique were included. Non-English published studies were excluded. The MEDLINE database was searched and supplemented by screening the reference lists of included studies. Each study is presented separately. In total, six studies including 14–42 patients (n=189) reported outcomes with a postoperative follow-up of 3–57 months. Five studies analyzed clinical outcomes after laparoscopic triple or selective neurectomy and one study reported outcome following only laparoscopic mesh removal. The outcome variables were often poorly defined and inconsistent between studies. However, results were generally promising in respect of reduction in pain and increase in activity level. The definition of a successful postoperative outcome was lacking in most studies making it difficult to assert definitive conclusions. What is clear, is that a laparoscopic approach to managing postoperative pain after inguinal hernia repair is feasible but with some risks. More specifically, an extraperitoneal laparoscopic neurectomy may benefit patients suffering from severe chronic pain after inguinal hernia repair. The literature does not provide evidence supporting a universal laparoscopic approach to chronic pain following inguinal hernia repair. More large-scale high-quality studies are warranted before final conclusions can be made on the indication to offer a laparoscopic pain-operation and the long-term outcome.