Dr. Enrico Stefano, expert in Colonproctology and General Surgery in Turin , explains what recovery after an inguinal hernia surgery consists of, underlining the importance of following the prescribed therapies to quickly eliminate postoperative pain
Inguinal hernioplasty: why do you feel pain after surgery?
The inguinal hernia is among the most frequent pathologies of surgical interest in man. Since there is no conservative technique or medical therapy that allows to cure an inguinal hernia, the treatment of the wall defect is only surgical. Nowadays prostheses made of non-absorbable material (MESH) are used which allow to perform an operation without sutures, in such a way as to avoid traction on the muscular planes.
Despite these attentions, hernioplasty still involves the separation of muscles and bands, factors that can traumatize the tissues. Furthermore, the non-absorbable net represents a foreign material to our body and takes time to be incorporated and integrated into the scar tissue, creating a certain degree of inflammation in the structures on which it rests. All this gives rise to pain of varying magnitude in the area where the operation was performed.
Traditional inguinal hernioplasty (in open surgery), which is generally performed with the Trabucco or Lichtenstein technique, still represents the standard in the treatment of this type of hernia. Anesthesia (which can be local or locoregional) is usually associated with short-term sedation, in order to make the treatment more bearable.
The alternative, especially in very large hernias or overweight patients, can be spinal anesthesia, in which a reduced amount of anesthetic is injected into the medullary canal to block the sensitivity of the inguinal area (seat of the hernia) and the limb corresponding.
Is it normal to experience pain following an operation?
Once the effect of the anesthesia is over, the tissues will still be inflamed due to the recent intervention and the painful terminals at the base of the postoperative pain will be activated . This represents the normal course, so it is sufficient to take painkillers for a few days in order not only to reduce the pain, but also to quickly reverse the inflammation. It is important not to try to resist pain, but to take the prescribed therapy at the set time: if you use painkillers only when the pain has already arisen and it becomes important, you will get less benefits.
Postoperative pain: when it is caused by a nerve injury
The pain postoperatively can also be caused by any damage to the nerves that are located in the groin area (ilioinguinal and genitofemoral). The ileoinguinal nerve, in particular, runs along the spermatic cord in a subfascial position and has the function of guaranteeing the skin sensitivity of the groin area, the thigh root and the lateral part of the scrotum. During a hernioplasty , this nerve must necessarily be isolated, moved and repositioned. The procedure can accidentally damage it and give rise to alterations in the sensitivity in the aforementioned area (localized hypoaesthesia) which tends to spontaneously regress with the passage of time. Sometimes, however, this lesser sensitivity may persist.
An annoying situation occurs if the nerve remains “trapped” in the scar tissue close to the prosthetic net: this condition is in fact not controllable as it is created during the healing and healing phase, and gives rise to irritation of the nerve fibers, resulting in postoperative neuralgic pain, burning and often intensified by prolonged physical activity or by sudden movements. In this case, taking pain relievers and / or anti-inflammatories for several days is essential and, in severe cases, it will be necessary to resort to several sessions of local infiltrations with local anesthetics (cortisone, anti-inflammatory, etc.) in order to reduce the ‘inflammation.
A further possibility may be a neuromodulation cycle trancutanea, performed in 4-6 sessions with a suitable equipment, in order to reduce the damage from nervous stretching.
If the neuralgic pain persists after months of treatment (rare event), the option of a second intervention to identify the nerve stretch point and dissect it can be considered, as the resulting hyposensitivity is far preferable to neuralgia and , if we removed the prosthetic net, we could face a recurrence of the hernia.
Hernioplasty: how long can you go back to playing sports?
In the first days following the operation, the scar reaction definitively fixes the mesh to the tissues in order to guarantee a good hold of the plastic, but the recovery of physical activity must still be gradual: you can start with a light walk in order to avoid efforts on the abdominal muscles. Furthermore, since movements at the level of the abdominal wall increase the stimulus on the operated area, the use of an elastic brace is recommended to reduce the tension in this area and support the muscles.
It will be possible to increase the intensity of physical activity (exercise bike, swimming, more intense walking) after about 2 weeks, when the scar tissue will begin to stabilize by correctly fixing the prosthesis. Finally, after a month, it will be possible to return to more intense practices, gradually introducing the effort on the abdominal wall.
Don’t be afraid of postoperative pain!
It is important to keep in mind that there are no painless surgeries, as the tissues that must be cut and stitched necessarily suffer from the procedure, and that at the end of the operation there will always be an inflammatory stimulus. Postoperative pain, of a more or less important extent, is a reality that exists and that, in most cases, it is possible to deal with adequate drug therapy, which takes time to be effective.
It is recommended to inform the doctor about any postoperative problems and not to underestimate them: acting promptly avoids the continuation and / or worsening of the problem, as well as the need to resort to more invasive procedures. A very frequent mistake by patients is to take the medicines in a reduced dose or for a period of time shorter than that prescribed by the specialist. This leads to a worsening of the clinical picture and inflammation tends to become chronic, making longer, invasive and demanding treatments necessary.
