Laparoscopic Approaches to Chronic Postoperative Inguinal Pain
Chronic postoperative inguinal pain refractory to medical management is a challenging condition with significant costs and impact on a patient’s quality of life and limited options for remediation and pain relief. Laparoscopic approaches to inguinal neurectomy are a valuable, highly effective adjunct in dealing with neuropathic postoperative inguinal pain. Safe and effective mesh removal may be facilitated by laparoscopic or hybrid techniques that allow for greater visualization and dissection of mesh from the posterior wall. Orchialgia may be improved with laparoscopic paravasal neurectomy. There is no one size fits all, as each approach needs to be tailored to the patient’s initial repair, pain symptoms and distribution, physical exam, imaging, and shared decision-making. A solid understanding of the anterior and posterior anatomy, mechanisms of injury, and laparoscopic and open routes to access pathology provides a broad range of options to tailor treatment and improve outcomes.