Pain and discomfort

I don’t mean pain immediately after the operation but pain or discomfort still present more than 3 or 6 months after the operation - long-term discomfort. If someone does get discomfort, grumbling on for several months it occurs mainly after inguinal or incisional hernia operations, but in theory can follow any type of hernia repair. The focus of this explanation will be on discomfort after inguinal hernia repair.

LONG TERM PAIN IS RARE – around 2-3%. People have been scared by reports of a 20% likelihood. That is simply not rue. My colleagues and I would not be doing this operation any more if that was the case.

Long-term pain is certainly an issue facing hernia surgeons and inguinal hernia repairs at the present time, because if it wasn’t for the rare possibility of discomfort, mesh inguinal hernia repair would almost be the perfect operation.

I think there are a number of factors at work here.

Firstly as I have pointed out it is not that it is not common, it is just that the operation is so good that the repair seldom fails and the hernia seldom returns. We expect a perfect result, with no hernia and a complete and rapid return to normal activities in a short time. So any other niggling problem short of a perfect result is noticed

Times have changed and we are in an age when we have high expectations. There is some evidence that post-op. inguinal hernia pain has always occurred, even before the use of mesh, but patients 20 or 30 years ago seldom went back to their doctor or surgeon to complain.

And the internet has allowed people to be very public about their problems, which they were never able to do before. As with most areas of life it is usually only the people who are unhappy about something who write about it. The satisfied ones don’t bother and just get on with their life. So browsing the internet you tend only to see the problems and scare stories.

When I talk to my experienced surgical colleagues, the ones do repair a lot of hernias, they, like me, are amazed at the reported percentages od post op pain – in some reports over 20%. They echo my personal experience that post op pain is relatively rare. I could not have continued if 20% of my inguinal hernia patients came back with post op pain.

The counter argument is that patients with problems often don’t want to return to their original surgeon – embarrassed or lost faith? But when we at the British Hernia Centre have sent out questionnaires we are seeing responses showing only 2 or 3% of patients having long term problems with discomfort. And I don’t believe that they would not tell us if they really were having problems. And almost all of the few pain problems of mine that I do see settle with the fullness of time.

I, along with some of my experienced colleagues, believe that part of the reason for the poor results ‘elsewhere’ is that the operation, with mesh, is being done badly or at least in a less skillful manner than it ought to be. When I read articles or clinical trials reporting 30-40% of patients having long term discomfort I can’t help but wonder what those surgeons are doing actually doing – or are they asking the wrong question?

How many of these people had pain before the operation, possibly unrelated to the hernia, which was therefore almost an incidental occurrence.

The real evidence is complex and confusing, and I will try to present it as clearly and simply as possible.

In the meanwhile take a look at a couple of articles