The primary goal of hernia repair has been to reduce hernia recurrence. Unfortunately, as mesh technology advanced and more surgeons were implanting various types of mesh, we began to see a national epidemic of chronic pain related to hernia repair surgery. In fact, in the case of groin (inguinal) hernia repair, mesh repair reduced the hernia recurrence rate from 15-25% down to 5%, or even below 1% if done by hernia specialists, whereas the chronic pain associated with mesh repair of the groin hernia rose up to 20% nationally. Chronic hernia pain is defined as a noticeable pain felt at the hernia site 3 or more months after surgery. One report suggested that 3% had chronic debilitating pain that was disabling and seriously affected the patient’s quality of life.

Chronic hernia pain is mostly seen after hernia repair of the groin, with mesh. The exact reason for this is unknown. In some patients, the inflammatory reaction from the mesh itself never subsides and this translates into a long-term chronic dull ache. In some patients, the pain is related to the technique of the hernia repair itself: perhaps the mesh was implanted incorrectly, too tight, or the handling of the tissue caused nerve damage or tissue damage. It is very important that your surgeon be very skilled not only in the technique of hernia repair but also have an intimate knowledge of the mesh products they use, the correct placement techniques of the mesh, and understand the risks and benefits of each mesh they use.

Non-mesh tissue repair of a groin hernia has significantly more pain immediately after surgery, however, because we are suturing muscle and fascia together, it eventually stretches and the pain from the tension in the repair usually subsides. The rate of chronic debilitating pain after non-mesh tissue repair is much lower than with mesh repair.

Dr. Towfigh is keenly aware of the epidemic of postoperative chronic pain after hernia repair, as a large proportion of the patients who seek her expertise suffer from this problem. She has noticed that the most common reasons for postoperative chronic pain include:

• Inappropriate choice of hernia repair technique for the needs of the patient
• Suboptimal choice of mesh produce for the needs of the patient
• Incorrect technique in implanting the mesh chosen
• Rough handling of tissue, nerves, spermatic cord structures during the operation
• Patient hypersensitivity to foreign body implantation

At the Beverly Hills Hernia Center, Dr. Towfigh is very careful to review your own personal status and risk for chronic pain. She will then tailor your options for hernia repair and provide you with techniques and plans that will maximally maximize your hernia pain relief after surgery. She has perfected techniques during surgery that lead to a higher chance of hernia pain relief or swelling after surgery. Also, she uses mesh available on the market that have a known profile to have the lowest risk of chronic pain after surgery. In some patients, it is wisest to use no mesh at all, due to the high risk of chronic pain after surgery: these may include thin women and those with fibromyalgia.