POSTOPERATIVE INGUINODYNIA IN LAPAROSCOPIC INGUINAL HERNIA REPAIR: A COMPARATIVE STUDY OF TAPP VERSUS TEP

Abstract

Inguinodynia, or chronic groin pain, following inguinal hernia repair is a significant yet often under-reported postoperative complication. While mild pain for a few days after mesh repair is common, moderate to severe pain persisting beyond three months is considered pathological. The causes are multifactorial, including neuropathic pain from injury or entrapment of inguinal nerves and non-neuropathic pain from mesh fixation, fibrosis, or foreign body reaction. Patients may experience a dull ache or sharp, shooting pain radiating along the ilioinguinal, iliohypogastric, or genital branch of the genitofemoral nerve. Lightweight meshes are preferred as they provoke less foreign body reaction and improve patient comfort. Identification and preservation of inguinal nerves during surgery have been shown to reduce postoperative pain, though the evidence comparing nerve preservation and neurectomy remains inconclusive. Both medical and surgical treatments are available but carry risks such as analgesic side effects, sensory loss, or hernia recurrence. Therefore, prevention through meticulous surgical technique, gentle tissue handling, and effective perioperative counselling remains the best strategy to minimize chronic postoperative pain and enhance long-term outcomes. Aim And Objective To compare the incidence of inguinodynia following TAPP and TEP laparoscopic repair. Materials And Methods This prospective observational study included 100 patients undergoing elective laparoscopic hernioplasty (50 TEP and 50 TAPP) at Saveetha Medical College, Chennai, between June 2022 and June 2024. Postoperative pain was assessed using a 4- point verbal scale (0–3) at 1 week, 1 month, and 6 months after surgery. Results The overall incidence of inguinodynia was 16%, with higher rates in TAPP (20%) than in TEP (12%). Increased pain in the TAPP group may be attributed to peritoneal flap dissection causing greater nerve irritation. Mild pain was about eight times more common than severe pain. Pain improved in most patients by 3 months (38%) and further by 6 months (16%). The majority (70%) of cases occurred in the 40–60-year age group. Conclusion Laparoscopic inguinal hernia repair using both TAPP and TEP techniques is safe and effective. However, the present study demonstrates that the incidence of chronic groin pain (inguinodynia) is lower following the TEP approach compared to TAPP repair. The higher rate of pain in TAPP may be related to peritoneal dissection and increased risk of nerve irritation. Most cases of inguinodynia were mild and showed progressive improvement within six months. Meticulous intraoperative nerve identification, minimal tissue handling, and the use of lightweight mesh are key factors in reducing chronic postoperative pain. Continued emphasis on surgical precision and patient follow-up can help achieve optimal long-term outcomes and improve quality of life after hernia repair