Initial experience of minimally invasive mesh explantation for inguinodynia

Background Chronic pain after minimally invasive inguinal hernia repair with mesh can have debilitating effects on quality of life (QOL), limiting daily activities and ability to work. Many medical and surgical options for treatment have been proposed, however there is no consensus on the role of mesh explantation in the management of these patients. Methods We performed a retrospective review of all patients who underwent groin mesh removal by robotic or laparoscopic approach from July 2012 to July 2023 at our institution. Patients were interviewed post‐operatively to determine their overall pain scores and QOL was assessed using the Carolinas Comfort Scale (CCS) Questionnaire. Patient characteristics, operative times, pre‐operative imaging techniques and analgesia use was also recorded. Results Twenty‐two patients underwent groin mesh removal for chronic pain, including 12 robotic and 10 laparoscopic operations. The mean pre‐operative pain score in all patients was 7.6/10 compared to 4.0/10 post‐operatively. The mean post‐operative CCS score was 24, indicating moderate discomfort. Four patients demonstrated CCS scores 90, indicating severe debilitating discomfort. The majority of patients had a reduction or total cessation of analgesia intake post‐operatively. Conclusion Both laparoscopic and robotic mesh explantation for treatment of chronic pain post‐inguinal hernia repair is safe and effective in achieving a reduction in pain and reducing the need for long‐term analgesia. Chronic pain post inguinal hernia surgery is becoming more common. Little information on guidelines is available for explantation of mesh. Our paper summarizes our experience with explantation of mesh with laparoscopic and robotic techniques.