Surgical Management of Chronic Postoperative Inguinal Pain

Chronic postoperative inguinal pain is a major quality-of-life issue after groin hernia repair. Several mechanisms may coexist, especially nociceptive and neuropathic pain, making diagnostic precision essential. Assessment relies on clinical history, physical examination, sensory mapping, the DN4 questionnaire, and exclusion of recurrence or mesh-related complications. Management should be specialized and multidisciplinary, combining pharmacological treatment, interventional procedures, and surgery in selected patients. In refractory neuropathic pain, triple inguinal neurectomy is the main surgical option, whereas mesh removal is rare but more relevant in nociceptive pain or mechanical complications. Careful patient selection, interpretation of diagnostic nerve blocks, and pain phenotype analysis are critical to improve outcomes. Prevention remains essential and includes identifying risk factors, choosing the appropriate surgical approach, and ensuring high-quality hernia repair technique.