Inguinal hernia repair ranks among the most frequent procedures in general surgery.[1] The condition can be addressed via open surgery or minimally invasive laparoscopic techniques. The two most common laparoscopic methods for inguinal hernia repair are the transabdominal preperitoneal (TAPP) approach and the totally extraperitoneal (TEP) approach.[2]

Chronic groin pain (inguinodynia) after hernia repair is a major concern, though frequently overlooked. Mild discomfort lasting a few days is typical following mesh-based repairs, but persistent moderate to severe pain beyond three months should be deemed pathological. The leading causes of chronic groin pain include neuropathic factors (resulting from inguinal nerve injury) and non-neuropathic factors (linked to the mesh or other elements). Neuropathic pain often presents as sharp, burning, or stabbing sensations that intensify with repeated stimuli. Additional symptoms may involve paraesthesia (tingling, crawling, or electric-like feelings) and dysaesthesia (abnormal, unpleasant sensations) spreading to the skin area supplied by the affected nerve. Given the risks of analgesic side effects, recurring pain, hernia recurrence, and significant sensory impairment, both nonsurgical and surgical treatments have been explored for persistent groin pain.[3,4]

The most effective strategy for managing persistent groin pain is prevention, achieved through meticulous handling of inguinal tissues during surgery and improved patient education before and after herniorrhaphy.

This study seeks to evaluate the occurrence of inguinodynia between two inguinal hernia repair techniques: the open Lichtenstein method and the laparoscopic approach.

Aims and Objectives

1. To study the incidence of inguinodynia in both methods of inguinal hernia repair, open Lichtenstein’s and laparoscopic method.

Study Design: Prospective cross sectional study.

Place of study: Silchar Medical College and hospital, Silchar.

SAMPLE SIZE : Study group consisted of total 50 cases who underwent inguinal hernia repair which included, 25 cases (group A) of open inguinal hernia mesh (Lichtenstien) repair and 25 cases (group B) of laparoscopic inguinal hernia repair.

Study period: The study was conducted from 1^st September 2024 to 30^th June 2025 over a period of 8 months.

Source Of Study: All patients of inguinal hernia presenting to the Surgery OPD or IPD or Casualty of Silchar Medical College and Hospital

Inclusion criteria:

• Patients with clinical/radiological diagnosis of inguinal hernia and who underwent inguinal hernia repair during time period of this study
• Age >18 and < 80 yrs.

 Exclusion criteria:

• Bilateral inguinal hernias.(to avoid bias)
• Recurrent inguinal hernia.
• Complicated inguinal hernia (obstructed, strangulated, incarcerated).
• Patients suffering from other pain syndromes and chronic disorders (spine traumas, diagnosed neuropathies, collagen vascular disease, chronic renal failure, bleeding disorders and immune compromised status)
• Non- compliant and psychiatric patients.

STUDY PROTOCOL: Patients were chosen based on the inclusion and exclusion criteria listed above. The study included all patients who underwent elective inguinal hernia surgery at Silchar Medical College and Hospital. In the OPD, patients were assessed on the seventh post-operative day and also once the third and sixth post-operative months will end.  Individuals experienced discomfort in the inguinal region for longer than three months following elective inguinal hernia repair were diagnosed with inguinodynia and undergo additional evaluation. Visual analogue scale (VAS 0-10) was used to assess the severity of pain.  Attempt were made to compare the incidence of inguinodynia in 2 methods of hernia repair.  Mean, standard deviation were used as descriptive statistics.  A p value of < 0.05 was considered as statistically significant. All the analysis was carried out using the standard statistical software.

The most frequently used self-rating pain tool is the visual analogue scale (VAS) which uses a scale of 10 cm in length, with no pain at 0 to severe pain at 10.

All these patients were subjected to detailed history taking, including history of pain including onset, duration, progress, severity and character of pain. Visual analogue scale (VAS 0-10) was used to assess the severity of pain.  Patients with inguinodynia were classified according to VAS into mild (score 1-3), moderate (4-7) and severe (8-10).

Demographic profile of the study groups-

Both the Groups in this study were comparable with respect to age, gender and duration of surgery.

Table 1: Distribution of patients with respect to age and method of hernia repair

Table 2: Distribution of patients with respect to gender and method of repair used

Table 3: Distribution of patients with respect to duration of operation and method of repair used

Table 4: Association between Overall VAS Score and Type of Repair Method Used (Open and Laparoscopic) In FIRST POST OP DAY

Table 5: Association between overall VAS score and type of repair method used (Open and Laparoscopic) in FIRST POST OP WEEK

Table 6: Association between overall VAS score and type of repair method used (Open and Laparoscopic) in THIRD POST OP MONTH

Table 7: Association between overall VAS score and type of repair method used (Open and Laparoscopic) in SIXTH POST OP MONTH

In recent years, inguinodynia has become increasingly significant in clinical practice. With recurrence rates after inguinal hernia repairs decreasing, surgeons now prioritize this condition as a major indicator of surgical success. Additionally, the frequency of inguinodynia plays a crucial role in selecting the optimal hernia repair method. However, assessing its exact incidence remains challenging due to the subjective nature of pain evaluation.

For decades, Lichtenstein’s tension-free mesh repair was considered the benchmark for inguinal hernia surgery. Recently, however, laparoscopic techniques have gained traction. Our research aimed to compare the rates of inguinodynia between these two surgical methods.

In our findings, the incidence of mild, moderate, and severe inguinodynia was 14%, 6%, and 0%, respectively. This contrasts with Callesen’s study, which reported rates of 19% for mild pain and 6% for moderate-to-severe pain [9]. Grant et al. noted debilitating pain in 2%–5% of cases [10], while Poobalan et al. found that roughly 10% of patients experienced moderate pain in their follow-up study [8].

Our study recorded inguinodynia rates of 24% for open surgery and 16% for laparoscopic repair. In contrast, Grant’s study reported 24.3% and 29.4%, respectively [10] .Statistical analysis revealed a significant difference (p < 0.05) in pain incidence between the two techniques at both the 3-month and 6-month follow-ups. However, no notable differences were observed in age, gender distribution, or surgery duration between the groups.

Bay-Nielsen et al. [5] identified female sex as an independent risk factor for inguinodynia, possibly due to women’s higher pain sensitivity and reporting tendencies. Interestingly, our study showed lower pain incidence in females, likely because of the smaller female cohort. A larger sample size is needed to confirm this association.

We draw the conclusion from this study that the overall incidence of inguinodynia is 20% and that the incidence is higher in open hernia repair than in laparoscopic hernia repair (24% in contrast to 22%). In addition to other prevalent explanations, the high prevalence of wound and scrotal complications may be the source of the high incidence of inguinodynia in the open surgery group.

Compared to severe inguinodynia, mild inguinodynia occurs more frequently. Over a 6-month follow-up period, a significant proportion of patients exhibited a tendency toward improvement in their inguinodynia. The majority of trial participants (50%) are between the ages of 50 and 65 and need intermittent analgesia to relieve their pain.

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2. McCormack K, Scott N, Go PM, Ross SJ, Grant A. Laparoscopic techniques versus open techniques for inguinal hernia repair. The Cochrane Library. 2003.
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