ModeratorAugust 22, 2015 at 6:05 am
Inguinal hernia recurrence
Pain after laparoscopic hernia repair can be due to a hernia recurrence and/or the mesh interacting with the contents trying to recur and push their way through the recurrence. Your surgeon is correct: most commonly, the most lateral edge of the mesh folds in, partially exposing the indirect inguinal hernia. It seems, based on your symptoms of pain with activity and relief with sitting and certain maneuvers, that these hernia contents are moving in and out through the area of the recurrence.
Once the open and laparoscopic hernia options have both been performed, then it is up to the discretion of the surgeon and the specific situation at hand whether the next hernia repair should be performed open vs laparoscopically. If your first repair was performed with mesh, then perhaps redoing it would be risky, with risk of spermatic cord and nerve injury. This is because the mesh is already stuck to these contents. However, if there is no mesh anteriorly, it is my opinion that revisional surgery is less risky in the open repair. You may have to have nerves cut. That is your surgeons discretion. Not all surgeons do that for every revision. It is done to reduce risk of postoperative nerve injury and pain.
I recommend imaging such as MRI pelvis to view the mesh repair, see if the mesh has shifted or is folded or balled up, and confirm recurrence. If the mesh itself is not the major issue, then open repair is safe and effective, and mesh should be implanted. Revisional laparoscopic repair is performed safely by only few surgeons who are laparoscopically experienced. If that route is chosen, make sure the surgeon performs these regularly.