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Pain after inguinal hernia surgery

It seems unbelievable, but even in the age of instant communication, where scientific knowledge can be transmitted and shared in real time, many Surgeons say that the problem of pain after inguinal hernia surgery does not exist, and that they do not remember having had, nor having treated, any patient with this type of problem.

However, the Literature reveals to us that in Centers where there is nodedicated abdominal wall surgery team, pain and burning after inguinal hernia surgery do exist, affecting, in extreme cases, as many as 60% of operated patients.

More realistically. Chronic inguinal pain after inguinal hernioplasty surgery may occur in about 20% of patients, predominantly outnumbering hernial recurrences, which instead occur in 3.3-10% of cases1.

But what exactly are we talking about?

Pain after inguinal hernia surgery, or chronic inguinal pain, is that pain that follows inguinal hernia surgery; it is due to nerve injury and must be present at least 3 months after surgery and persistent for at least 6 months. It can be caused by, among other things, inflammatory reactions of the periosteum of the pubis (the periosteum is a thin, tough membrane that lines the bones; pain in this case may be triggered, for example, by the so-called "stitch on the pubis" that so pleases surgeons not especially dedicated to hernial surgery, and which has been absolutely proscribed by wall surgeons for years now), by nerve injuries occurring during surgery fromentrapment of nerve branches in the inguinal region at mesh fixation sites (for this we prefer the Trabucco technique, which does not require stitches on the mesh), from "perforations" of nerve branches due to theuse of tacks (tacks are clips, usually resorbable, that can be used laparoscopically to fix the mesh; although wall surgeons well know that, for example, in laparoscopic inguinal hernia surgery, it is not necessary to fix the mesh...) or from theinclusion of nerve branches in "meshomas " ("mesh" = mesh), granulomatous lesions caused by the inflammatory reaction of the patient's tissues toward the implanted mesh (normally in the case of heavy or not well stretched mesh; that's why wall surgeons, well aware of this problem, try whenever they can to use light mesh).

Pain after inguinal hernia surgery may be associated with paresthesias (i.e., "different" skin sensitivity than normal), hypoesthesias (i.e., reductions in skin sensitivity), and hyperesthesias (i.e., a conspicuous increase in skin sensitivity), and radiate toward the scrotum, labia majora, and Scarpa's triangle (the root of the thigh). Symptoms may be triggered, or exacerbated, by certain positions, such ashyperextension of the thigh, or activities, such as walking; and sometimes may decrease with thigh flexion or when lying down.

Following inguinal hernia surgery, pain months after surgery can thus be defined as chronic inguinal pain; and chronic inguinal pain can cause changes in the central nervous system that contribute to its persistence and aggravation. The consequence is the appearance of two conditions that are typical of chronic groin pain:hyperalgesia (exaggerated response to painful stimuli) andalodynia (pain triggered by stimuli that would not normally elicit any painful response). Therefore, it is important to treat postoperative inguinal hernia pain before it becomes chronic, since its chronicity implies plastic changes in the brain centers of pain: early treatment, on the other hand, can prevent such changes from occurring.

Pain after inguinal hernia surgery: how to treat it?

The initial treatment of the pain after inguinal hernia surgery is medical; only later is surgery used. The first, fundamental step in the Treatment of pain and burning after inguinal hernia surgery is to draw a Skin map of the pain itself, as in the figure opposite. With the patient lying down, you Inguinal hernia pain after monthsprovoke tactile stimuli in the groin region affected by the pain: depending on the type of sensation reported by the patient (pain, hypoesthesia, normoesthesia, hyperesthesia...) a circle or a cross of different color is drawn at the various stimulated points. Eventually you will get a map like the one opposite, which will allow the surgeon to know which injured nerve is causing the pain. The Surgeon will then prescribe topical or oral medication, according to a well-established and validated schedule: if, at the end of the treatment period, there is no satisfactory improvement, the Surgeon will propose surgery.

The surgery for the treatment of chronic inguinal pain consists of triple neurectomy, that is, theremoval of the nerve branches that cause the onset of the pain itself. This surgery can be performed either by the traditional route, reoperating the inguinal region (with the risk, however, given the inflammatory and scarring processes following hernia repair surgery, that the nerve branches will be very difficult to identify), or by the laparoscopic route, with an extremely refined technique. Our group prefers this second route, although sometimes it may be necessary to use a mixed technique, either open or laparoscopic, to satisfactorily complete the operation.

In conclusion, when a Surgeon treats a person with chronic groin pain he must, first of all, become a Physician again; and not just any Physician, but the best Physician possible for his "patient. In the end, only in the end, he must put on the shoes of the Surgeon again; and not just any Surgeon, but the best Specialist Surgeon possible.

Do you suffer from chronic groin pain resulting from inguinal hernia surgery? Contact us!

1. K.-J. Lundström H. Holmberg A. Montgomery P. Nordin. Patient-reported rates of chronic pain and recurrence after groin hernia repair. Br J Surg. 2018;105(1):106-112


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Dr. Salvatore uccomarino
Medical Surgeon Specialist in General Surgery
Laparoscopic inguinal hernia surgery REPA, the minimally invasive endoscopic surgery for diastasis of the rectus
51 Amerigo Vespucci Street
Phone 0110438161
inguinal hernia, crural hernia, hernia, laparoscopy, laparoscopic inguinal hernia
Inguinal hernia in laparoscopy, why?

Laparoscopic surgery of inguinal hernia 

When, after diagnosis, I propose to a patient to operate on his inguinal hernia laparoscopically, it is natural for me to be bombarded with questions.

In fact, inguinal hernias can be operated on under local anesthesia using relatively simple, widely standardized, and highly effective techniques.

Laparoscopic inguinal hernia, inguinal hernia surgery, inguinal hernia, inguinal hernia pain, inguinal hernia surgery,

However, there are many considerations in favor of laparoscopic inguinal hernia repair., that chart the way in choosing the technique.

The first comes from a long way back; from 1647 even, the year when French physicist and mathematician Blaise Pascal discovered his famous law.

In his experiment, Pascal introduced a 10-meter-long pipe into a barrel filled with water, then filled the pipe with water as well: the result was that the pressure inside the barrel increased so much that it broke.

Applied to hernia surgery, Pascal's law tells us that when the mesh we use to repair a hernia is placed on the inner surface of the herniated defect area, it is the same pressure present inside the abdomen that anchors it to the abdominal wall; whereas if we place it on the outer surface, the pressure tends to make it detach.

So operating aninguinal hernia laparoscopically means to perform a surgery in which the repair is more stable than that done "from the outside." And this is a very, very good reason to propose the surgery of repairing the inguinal hernia in laparoscopy..

Another important reason is that by operating on aninguinal hernialaparoscopically, we are able to diagnose the possible presence of other wall defects, which are often present in these patients and not looked for or not seen by the examiner-such as, for example, an umbilical hernia or a contralateral inguinal hernia, i.e., on the other side, a crural hernia-and repair them during the same surgery.

TAPP hernioplasty - plug

Third, equally central reason: laparoscopic inguinal hernia surgery causes much less postoperative pain than surgery performed conventionally.

What's more, many (most) surgeons who operate openly have the habit of using "plugs ," which are sort of "plugs" of plastic material that are inserted into the inner inguinal ring for the purpose of reducing its size. This is a very bad habit, because these plugs have an unpleasant tendency to migrate, often ending up inside the abdominal cavity and causing adhesions with the intestinal loops, which, in the most serious cases, can end up injured by these plastic boulders, up to intestinal perforation.

In the photograph above, here is what we found in one of our last surgeries: a plug that had entered the abdominal cavity, causing severe adhesions with peritoneal fat and intestinal loops. And it was not the firsttime.

Remember: if you are going to have surgery for aninguinal hernia, ask the Surgeon if he plans to use a plug; if he says yes, think about it!

So, summing up:


Better repair of the herniated defect, with larger mesh and optimal tightness
Ability to diagnose and repair other hernias that escaped diagnosis during surgery
Less postoperative pain

These are the reasons - and they are not a few! - to propose laparoscopic inguinal hernia repair surgery. Add to this the fact that, for years now, the scientific community of surgeons dealing with the abdominal wall has established that laparoscopic inguinal hernia surgery represents the "gold standard" for the treatment of this frequent, bothersome and sometimes very serious condition.

However, probably following ingrained habits that make open inguinal hernioplasty surgery a surgery that can be performed by any surgeon, even those who are not particularly specialized in abdominal wall surgery, and also because laparoscopic inguinal hernia surgery is by no means simple, but involves a long and arduous learning curve, today the vast majority of surgeons do not engage in laparoscopic inguinal hernia surgery. Obviously, to the great detriment of the patient.

Laparoscopic inguinal hernia surgery in my center

laparoscopic inguinal hernia

For years I have been working to make my center, the St. Catherine of Siena Clinic in Turin, Italy., a Center of Excellence for the treatment of abdominal wall pathologies, particularly insisting on minimally invasive laparoscopic surgery. I introduced, first in Europe, the endoscopic diastasis surgery of the rectus abdominis muscles (of which I now hold the largest case history in the world) and, first in the world, the surgery of large laparoceles by endoscopy, with an original technique derived from the Carbonell-Bonafé technique, also with preoperative preparation with botulinum toxin and progressive pneumoperitoneum for the reconstruction of the space in the abdominal cavity (techniques well known and widely used abroad, but practically unknown in Italy; in this, too, excuse my lack of modesty, I arrived first...). Continuing on the path of offering the patient the best possible therapeutic choices, and in line with international recommendations, I have decided to offer inguinal hernia repair by laparoscopy to all my patients.. Operationally, for the patient this involves general anesthesia instead of local, and one night of hospitalization.

How does the surgery take place? You can take a look at the video below to understand the basic surgical steps forlaparoscopic inguinal hernia repair.

How to get enrolled for this surgery? Simply schedule an appointment or a video consultation.


Otherwise, you can contact me with the form below:

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What our patients think of us is much more important than what we say.

Dr. Salvatore Cuccomarino
Cuccomarino, MD
Medical Surgeon Specialist in General Surgery
19 Villa della Regina Street
Phone 0118199300


Laparoscopic recurrent inguinal hernia
Recurrent inguinal hernia? better laparoscopy

Recurrent inguinal hernia: what is it?

L'inguinal hernia belongs to the large family of hernias of the abdominal wall and represents one of the most frequent diseases of surgical interest worldwide: it is estimated that hernias in general affect 5 to 7 percent of the population, and of these about 75 percent are inguinal hernias. In other words, about 2,736,000 people in Italy are affected by inguinal hernias. The majority of these patients end up undergoing surgery, which, in the first instance, is a relatively uncomplicated procedure that is performed under local anesthesia and requires only a few hours of hospitalization. However, in not a small percentage of cases, the repair, for a variety of reasons (ranging from errors in technique to the patient's failure to follow the rules imposed by the surgeon in the postoperative), fails; the hernia reforms: we speak, in this case, of recurrent inguinal hernia.

Recurrence: a frequent problem in inguinal hernias

Modern surgical techniques and the use of prostheses have substantially reduced the rate of recurrence after inguinal hernia surgery; however, a recent study, conducted on more than 46. 000 patients in Denmark, showed that the incidence of inguinal hernia recurrence continues to affect about 4 percent of patients; less than the double-digit percentages observed before the advent of mesh: but, taking into account the numbers reported earlier, theoretically in Italy alone,inguinal herniarecurrence affects more than 100,000 patients-a not a small city!

The problem then facing the Surgeon is: what is the correct treatment of recurrent inguinal hernia?

What is the correct treatment of recurrent inguinal hernia?

Most Surgeons treat therelapsed ing uinal hernia exactly as they had treated the primary inguinal hernia: that is, they operate on it anteriorly, redoing a surgical incision on the previous one, and trying to put a "patch" on it as best they can-very often "inventing" on the spot some variation of the most commonly used surgical techniques (which, in the act, also seems like a good solution). This, unfortunately, is conceptually wrong, as well as going against the indications of the main guidelines available today.

Operating a recurrent hernia with the traditional incision when the primary hernia has already been operated on anteriorly means re-injuring tissue over which the surgeon had already passed during the previous operation, in an area where the anatomy has been profoundly altered by the surgery undergone by the patient anyway, and where there are very intense fibrotic phenomena due to the presence of the mesh: the risk of vascular and nerve injury and postoperative pain increases, and by a great deal; the wall of the inguinal region is further weakened, and the risk of recurrence increases. The patient risks being entangled in an endless and painful odyssey.

Hernia recurrence: better laparoscopy

Le guidelines, in this case drawn up by the European Hernia Society, speak clearly: Recurrent inguinal hernia, guidelines, European Hernia Society

"If previously anterior: consider open preperitoneal mesh or endoscopic approach (if espertise is present)" - i.e., if the patient has previously been operated on anteriorly, open repair with mesh in the preperitoneal position (e.g., Stoppa's or Wantz's techniques) or the endoscopic technique are indicated, provided expertise is present, i.e., there is a Surgeon experienced in this procedure.

In fact, in Italy - for a thousand reasons, which it is not the case to analyze here - there are few Surgeons able to try their hand at inguinal hernia repair laparoscopically, especially if it is arecurrent inguinal hernia (and perhaps even fewer who are able to perform an operation with Stoppa or Wantz technique). These are difficult cases, with altered anatomy in any case (even if, "going from the inside," i.e., from the inner surface of the inguinal region, one is working in seemingly "virgin" territory), which can only be addressed by experienced surgeons. But the advantages are clear: one has the possibility of repairing the herniated defect with a significantly larger mesh than is used in traditional hernia surgery, placed in a "healthy" area than where the surgeon had previously worked; and not infrequently, one may find that one is actually not dealing with arecurring inguinal hernia, but with a new hernia, perhaps unnoticed during the previous surgery, or perhaps formed later; and that, lo and behold, there is also a hernia on the other side, in the other inguinal region, which neither the patient nor the surgeon had noticed, and which can be repaired during the same surgery, before it begins to bother. Not to mention that postoperative pain is significantly less than with traditional surgery, and the patient can return to his or her activities much more quickly.

The video of the surgical technique

And here, finally, is a video of a recent surgery I did for recurrent inguinal hernia, performed laparoscopically (T.A.P.P. technique, Trans Abdominal Pre Peritoneal). This was a utrasectomy patient in his fourth recurrent hernia (!!! That is, three other surgeons had already operated on him by going through the anterior route, evidently without great results). Not an easy surgery, as expected, but successfully concluded to the patient's satisfaction. The mesh, as prescribed by the guidelines, is placed in the preperitoneal space, but without the large incisions required for Stoppa or Wantz techniques (in fact, the patient will be left with three small scars, two 10 mm and one 5 mm...).

The patient was discharged the day after surgery, and had no discomfort or complications in the postoperative period. These results are obtained in the vast majority of cases of patients operated on laparoscopically. But - I repeat - laparoscopic inguinal hernioplasty , especially in cases of recurrent inguinal hernia, is not for everyone, and must be performed by an experienced surgeon.

Enjoy your viewing!

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Dr. Salvatore Cuccomarino
Cuccomarino, MD
Medical Surgeon Specialist in General Surgery
Corso Galileo Ferraris 3
Phone 0110438161

inguinal hernia symptoms, inguinal hernia surgery, scrotal hernia, inguinal hernia symptoms, inguino-scrotal hernia, strangulated hernia, adult umbilical hernia, inguinal hernia surgery, inguinal hernia photo, inguinal hernia surgery, testicular hernia, abdominal laparocele, hernia symptoms, umbilical hernia surgery, inguinal hernia recurrence, crural hernia symptoms, spigastrium hernia, inguinal hernia photos,hernia symptoms, female inguinal hernia, inguinal hernia surgery, umbilical hernia surgery, epigastric hernia symptoms
Abdominal wall surgery in the cancer patient

inguinal hernia symptoms, inguinal hernia surgery, scrotal hernia, inguinal hernia symptoms, inguino-scrotal hernia, strangulated hernia, adult umbilical hernia, inguinal hernia surgery, inguinal hernia photo, inguinal hernia surgery, testicular hernia, abdominal laparocele, hernia symptoms, umbilical hernia surgery, inguinal hernia recurrence, crural hernia symptoms, spigastrium hernia, inguinal hernia photos,hernia symptoms, female inguinal hernia, inguinal hernia surgery, umbilical hernia surgery, epigastric hernia symptoms

Abdominal wall surgery

Abdominal wall surgery is a superspecialty surgery, in many respects more complex than most other abdominal surgeries (except, perhaps, pancreatic surgery and metabolic surgery), requiring years of study and application, and a very detailed knowledge of human anatomy, to be successfully performed. In our unfortunate country, by many of the many, too many big wigs in our own health care, abdominal wall surgery is considered a minor branch of the medical sciences; but one only has to cross the Alps to see how much it is valued, and even feared, in the international surgical environment. And this is well understood when one looks at the disasters, due to surgical unpreparedness, often combined by those who approach the operating table without due respect for the abdominal wall: which, it should be remembered, is one of the load-bearing walls of the "house" in which we live, our body. How would one live in a house with gutted walls? The quality of life would be abysmal; and abysmal is the quality of life of those who are recklessly operated on by those who do not know the laws-often very complex-that dictate that we follow the abdominal wall.

The history of abdominal wall surgery

abdominal wall surgery, inguinal hernia symptoms, inguinal hernia surgery, scrotal hernia, inguinal hernia symptoms, inguino-scrotal hernia, strangulated hernia, adult umbilical hernia, inguinal hernia surgery, inguinal hernia photos, inguinal hernia surgery, testicular hernia, abdominal laparocele, hernia symptoms, umbilical hernia surgery, inguinal hernia recurrence, crural hernia symptoms, spigastrium hernia, inguinal hernia photos,hernia symptoms, female inguinal hernia, inguinal hernia surgery, umbilical hernia surgery, epigastric hernia symptoms,La history of abdominal wall hernia surgery È the History of Surgery: all the greatest Surgeons, all those whose names are remembered, have applied and contributed to it. I have spoken about it at several national and international conferences and courses, because it is a fascinating tale; just as fascinating is the History of the invention of the prostheses we use today in abdominal wall surgery: to the eye, small sheets of plastic, but with extraordinary technological content inside that rests on more than a century of scientific research.

Course on abdominal wall surgery in the cancer patient

It is therefore a great honor for me, and a great pride, to participate, as the ONLY ITALIAN INVITED SPEAKER among dozens of sacred monsters of Spanish (among the best in the world) and Hispanoamerican Surgery, in the International Course of Abdominal Wall Surgery in the Oncological Patient organized by the Sociedad Hispanoamericana de Hernia and by theUniversity of Valencia next October.

The course is sponsored by the Generalitat Valenciana, the Asociación Española de Cirujanos and theInstituto Cervantes, to name but a few of the major Spanish institutions that have shown interest in our work; as well as by numerous international Scientific Societies.

We will hold our country's flag high, and honor our work!