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Post-herniorrhaphy groin pain

Author
Janina B Bonwich, MD, FACS
Section Editor
Michael Rosen, MD
Deputy Editor
Wenliang Chen, MD, PhD

INTRODUCTION

Pain following hernia surgery is common but should subside within an expected time interval of about two months. For many patients, some degree of pain persists, and some patients develop moderate to severe pain that can be disabling or interfere with sexual function [1-3]. A presumptive diagnosis of post-herniorrhaphy neuralgia can be made when pain persists for more than three months following hernia repair, and is not related to other causes.

The clinical features, diagnosis, and management of persistent pain following hernia repair and surgical treatment of post-herniorrhaphy neuralgia will be reviewed here. The general issues surrounding hernia repair, including measures for preventing post-herniorrhaphy pain, are discussed elsewhere. (See "Overview of treatment for inguinal and femoral hernia in adults" and "Laparoscopic inguinal and femoral hernia repair in adults" and "Open surgical repair of inguinal and femoral hernia in adults".)

NERVES OF THE GROIN

The cutaneous nerves of the lower abdomen and groin that are most frequently implicated in the etiology of persistent groin pain following hernia repair include the ilioinguinal, iliohypogastric, genitofemoral, and lateral femoral cutaneous nerves (table 1). These nerves arise from the lumbar plexus and provide cutaneous sensory innervation for the groin, upper hip, and thigh regions (figure 1) [4-7].

The ilioinguinal, iliohypogastric, and lateral femoral cutaneous nerves travel along the anterior surface of the quadratus lumborum, and the genitofemoral nerve runs along the anterior surface of the psoas major muscle before piercing the abdominal wall (figure 2A-B).

The ilioinguinal nerve emerges lateral to the internal ring (figure 3) traveling toward the external ring [8]. The anterior branch of the iliohypogastric nerve is located more medially between the external oblique aponeurosis and the underlying internal oblique muscle (figure 3).

                    

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Literature review current through: Nov 2016. | This topic last updated: Mon Jun 27 00:00:00 GMT 2016.
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