Chronic postoperative inguinal pain (CPIP)
Chronic ingunial pain / groin pain can develop with and without previous inguinal hernia repair. Chronic ingunial pain can be diagnosed and treated by ZweiChirurgen at their “Competence centre for hernia surgery” in Switzerland in Basel, Zurich and Liestal.
When the groin pain occurs without prior surgery the most frequent causes are pathologies of the muscles, of the pelvic bones, of the lumbar spine, of the genitals, or intestinal structures. In contrast to widespread assumptions inguinal hernias don’t cause groin pain, except from an acute incarceration of bowel in the hernia. When chronic groin pain develops after inguinal hernia repair and last longer than three months, we speak of a chronic postoperative inguinal pain syndrome (CPIP).
In total about 6-8% of patients suffer from CPIP. The reason for CPIP is mostly an inadvertent damage of one or more of the three sensitive nerves in the groin, usually due to suboptimal surgical technique. This explains the lower rates of CPIP in specialized hernia centers such as ZweiChirurgen, where CPIP rates are less than 1%.
In a few cases CPIP can occur due to ingrowth of the nerves in scar tissue of the sutures or the mesh. Besides surgical expertise, diagnostic and treatment of CPIP demands a careful physical examination, detailed medical history taking, and the use of imaging modalities (MRI). Also, a pain mapping should be performed to get a clear understanding of the problem and the affected nerves. In some cases, repeated infiltration of the groin with a long-acting local anesthetic agent can induce continuous pain reduction (“desensibilization”). In some cases a percutaneous nerve ablation or a surgical neurectomy (with or without mesh removal) is necessary to treat CPIP successfully. The overall success rate for treating CPIP is 75-80%.
- Interdisciplinary diagnosis and treatment (Radiology, pain specialist, physiotherapy, hernia specialist)
- Pain mapping
- Infiltration of local anesthetics
- Laparoscopic and open neurectomy