Pain persisting beyond the first few days after groin hernia repair is recognized to affect small numbers of patients, generally estimated to be 10–15% of hernias repaired. In nearly all of these patients, the pain subsides postoperatively over the early months. Chronic, disabling pain persisting at and beyond 1 year is thought to be real but rare, affecting less than 1% of patients undergoing inguino-femoral hernia repair. Indeed, Devlin indicates that every year “some 400,000 inguinal hernias are repaired, and yet even the biggest series of reports of pain after inguino-femoral hernia repair from the United States are of only 17 or 23 cases. Therefore, this must be a remote hazard… .”1
Severe chronic pain following hernia repair is usually due to ischemia or to neuropathy. Ischemia induced in musculofascial tissues by a repair done under tension is the most common cause of undue postoperative pain. In this situation, the sutures slowly cut through the tissues, relieving the pain but setting the stage for recurrence. The other major cause of ischemia-induced pain is tight closure of either the deep or superficial inguinal ring during repair. Most often, ischemia in the ring is partly due to edema following operative dissection, and resorption of edema postoperatively leads to gradual resolution of pain; rarely does testicular atrophy supervene.