Post-Operative Inguinodynia From Hernia Surgery
by Jeffrey B. Mazin, MD, FACS
As an expert in hernia surgery and a referral center for difficult hernia patients, one
of the most challenging problems that I have encountered with increasing frequency is
post-operative inguinodynia from hernia surgery. This term refers to persistent groin pain
after hernia repair. A host of possible causes for the pain have been implicated. Men are
primarily affected by this syndrome but women have also been known to be plagued by
inguinodynia. In this article, I will present an overview of this problem and attempt to
give insight on this difficult and costly syndrome which has become increasingly prevalent
in the workers’ compensation arena, as well as in the private sector.
Background
This relatively newly-recognized syndrome has become a modern day plague on the claims
examiner, the treating surgeon, and the patient. Diagnosis, etiology, treatment, and
generally interacting with these patients are challenging for all those involved. An
integral part of this problem is knowing if the patient is a reliable historian,
psychologically sound, and whether the patient is merely posturing for secondary gain.
Personally, I have seen inguinodynia appear months or years after hernia surgery, and only
after the injured worker retained legal representation—usually due to an unrelated
issue such as back pain. Interestingly, the most current surgical literature reveals that
over 90% of inguinodynia occurs in workers’ compensation patients. Of those 10%
remaining patients with inguinodynia, only a fraction of them is without litigious intent.
This has prompted some authors to believe that inguinodynia is synonymous with the patient
posturing for secondary gain and using symptom amplification (see Table 1). This situation
has been in question until recently.
Neuropathy of Inguinodynia
Inguinodynia can occur in the immediate post-op period or can occur months after hernia
surgery. The most difficult scenario presents when the patient experiences a window of
three to six months after surgery without complaints then returns complaining of pain on
the operated side. Then there are those patients with obvious pathology who present with
unrelenting pain without reduction in intensity of the pain from the date of surgery. 15
to 30% of hernia patients will develop a post-op neuropathy or a nerve irritation symptom
complex. Symptoms of neuropathy are usually described as burning with irradiation to the
upper inner thigh, lower abdomen, testicle, scrotum, base of the penis, or labium. A list
of potential causes of inguinodynia is presented in Table 2.
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— April 2010
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