Dr Harsh Shah
MS, MCh (Surgical Gastroenterology), DrNB (Surgical Gastroenterology)
Registered with Gujarat Medical Council, Reg. No. G-38738
Robotic Hernia Surgeon · Apollo Hospital, Bhat, Gandhinagar · Gota OPD, Ahmedabad
In short
A small number of patients whose groin hernia was repaired correctly still have pain months afterwards. They are often told it will settle, and for many it does.
For those in whom it does not, the problem is real. It has a name, and it can be treated. But only once someone works out which of several quite different causes is responsible.
Pain lasting beyond three months after a groin hernia repair is called chronic post-herniorrhaphy inguinal pain. Being given the label is not the same as being given a diagnosis.
Nerve pain. Three nerves run through the operative field: the ilioinguinal, the iliohypogastric, and the genital branch of the genitofemoral. Any of them can be caught in a suture, squeezed by scar, or injured.
The pain is usually burning or electric. It runs in a defined strip of skin. It is provoked by extending the hip, or by touch. This is the commonest cause of genuine chronic pain, and it is a nerve problem rather than a mesh problem.
Scar and mesh discomfort. A dull, dragging ache with stiffness on twisting, worse after a long day. It usually improves over the first year.
A recurrence. Pain with a bulge that comes back. This is the cause that must be excluded first, because it is the one with a different operation attached to it.
Something that was never the hernia. Hip arthritis, adductor tendinopathy, an irritated lumbar nerve root, or pelvic disease can all produce groin pain, and can sit alongside a hernia. If the pain was there before the operation and is unchanged afterwards, the hernia was probably not its source.
A useful assessment does three things, in order.
First, exclude recurrence. Examination standing and straining, with ultrasound or CT where there is any doubt.
Second, map the pain. Where exactly is it. What provokes it. What is its character. Does it follow a nerve. Altered feeling in a defined strip of skin points strongly to a nerve.
Third, test the answer. A local anaesthetic block of the suspected nerve is both a test and a treatment. If the pain goes while the block is working, the nerve is implicated, and that finding guides everything after it.
Operating on chronic groin pain without this sequence is how patients end up with a second operation and the same pain.
Sorting the cause of groin pain after a hernia repair
| Cause | What it feels like | What settles it |
|---|---|---|
| Nerve injury or entrapment | Burning or electric, in a strip of skin, worse on stretching the hip | Map it, then block it. Nerve pain medicines. Surgery only after a block confirms the source |
| The hernia has come back | A lump that returns on standing or coughing, with an ache | Examination standing and straining, then ultrasound or CT |
| Scar or mesh discomfort | A dull drag, stiff on twisting, worse late in the day | Usually improves over the first year. Physiotherapy helps |
| Hip, adductor or spine | Deep groin pain, often present before the operation too | Hip and adductor examination, then physiotherapy |
| Fluid at the repair | A soft swelling in the first weeks, not much pain | Usually settles on its own. Reviewed if it is getting bigger |
If groin pain has outlasted three months, it needs a proper work-up rather than more waiting.
Time. Most groin pain after surgery improves a great deal over the first six to twelve months.
Medicines aimed at nerve pain. Ordinary painkillers often do little for nerve pain. Medicines used specifically for it work better. They deserve a proper trial at a proper dose before anything is called a failure.
Nerve blocks. A test, and sometimes a lasting treatment. A series is sometimes used.
Physiotherapy. Above all where the hip or the adductor is part of the problem, which is more often than people expect.
Surgery, in selected cases. Where a block has confirmed a nerve source and other treatment has genuinely failed, operations to divide the nerves involved, and occasionally to remove mesh, are considered. This is a considered decision after a full work-up, not a first response. The likely outcome should be discussed frankly beforehand.
Discomfort for a few weeks is expected. Pain lasting beyond three months is called chronic, and deserves assessment rather than reassurance alone.
Often it is not. Nerve injury or entrapment is a commoner cause than the mesh itself. The distinction matters, because removing mesh will not help nerve pain and carries real risk.
A patch of numbness after a groin repair is common, and usually settles. Numbness that persists together with burning pain in the same area suggests a nerve is involved, and is worth assessing.
Not reliably. Mesh removal is a demanding operation with its own risks. It is considered only when the work-up points specifically at the mesh, and other treatment has failed.
It can. That is why recurrence is excluded first, by examination and imaging, before the pain is put down to nerves or to mesh.
The main page on this site is robotic hernia surgery in Ahmedabad. These cover the neighbouring questions.
Where to find us
Dr Harsh Shah, MS, MCh (Surgical Gastroenterology), DrNB (Surgical Gastroenterology)
Shah's Gastro, Cancer & Robotic Surgery Centre
Apollo Hospital, Bhat, Gandhinagar
Gota OPD, Ahmedabad
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