Postoperative Pain for Patients with Herniorrhaphy, Lichtenstein Procedure-Review of Literature

The Lichtenstein procedure is currently the most widely used technique for open-inguinal hernia. Chronic muscular pain (chronic inguinodynia-CPIP) is a true health problem, that can influence the quality of life, given its increased incidence (up to 20% in some studies) in the context of inguinal hernia cure being one of the most common surgery. We have made a review analysis of the causes, the etiopathogenic mechanisms and the treatment methods of CPIP using the information available in numerous articles on this subject. Chronic pain (CPIP) is defined as pain that persists for more than 3 months postoperatively after the hernia surgery. There are three types of CPIP: sensory pain, neuropathic pain and mixed pain. Responsible for Lichtenstein pain are: intraoperative damage to the nerve inside the inguinal canal (iliohypogastric, ilioinguinal and genitourinary nerve of the genital tract), tissue lesions and synthetic meshes which lead to the appearance of a local inflammatory response. It appears that the most important factors involved in the appearance and persistence of pain are: weight of alloplastic material, patient age, postoperative complications and hernias recurrences. In most cases, pain is controllable with painkillers and anti-inflammatory treatment, but there are cases that do not respond to conservative treatment. Refractory to drug treatment cases benefit of pre or postoperative anesthetic nerve blockade or surgical treatment. The main methods of surgical treatment include either resection of the affected nerve by suture, or sperm funnel release or removal of alloplastic material responsible for the persistence of the painful sensation. The incidence and intensity of CPIP can be achieved by: accuracy of the surgical act with the prevention of tissue lesions and herniated relapses, the intraoperative highlighting of the 3 nerve structures within the inguinal canal and the avoidance of their injuries and the use of alloplastic quality materials.