Reply To: In the 70s and 80s hernias were no big deal –now they are hell
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There’s quite a lot on chronic pain Good Intentions…
” Putting tension on the inguinal ligament through stitching this up to the muscle (the Bassini Repair is a tension repair) may also lead to this problem. Neuralgia Another cause of chronic discomfort can be chronic pain from dam aged nerves. The nerve may be caught up in scar tissue or the nerve may have been cut and the raw end form a neuroma (a swelling on the end of the nerve) or the nerve could get caught with a stitch (this is potentially one advantage of not stitching the mesh in place). Experience, careful surgery and attention to identifying nerves during the procedure will help reduce this problem. Neuralgia is less common but more difficult to treat than osteitis pubica. It may respond to one or all of the following; steroid injection, reoperation and dividing the affected nerve (neurectomy) or very rarely actually removing the mesh. Mr Sadler is not aware of any of his patients ever requiring mesh removal. To try and reduce the chances of chronic pain we favour the use of a mesh that requires no stiches to hold the mesh in place, this has both the advantage or performing a tension free mesh repair and avoids potentially catching nerves with stitches. However, we still have pa tients who have discomfort that comes on after surgery (usually os teitis pubica) this appears to be about 2% of inguinal hernia patients. It still means that most patients don’t have any problems at all with a mesh repair. Chronic pain after umbilical, epigastric or femoral repair appears to be rare. If you develop chronic pain, then obviously Mr Sadler will be happy to see you in clinic to discuss treatment options. “.