Nerves management Avoiding nerve entrapment and injury is critical. The current consensus is that routine identification and preservation of nerves is the best method for prevention. Transection of the nerves routinely is not a recommended strategy, as it can sometimes increase the pain further. It also increases sensory disturbances in the area of distribution of the transected nerve. No identification at all is the worst, and many surgeons are not making this identification. For example, in daily practice, surgeons identify all three inguinal nerves as three single nerves in less than 40% of the cases, while the literature shows that this identification can be done in 70-90% of the cases. The challenge is that the course of both ilioinguinal and iliohypogastric nerves is found to be consistent with that described in anatomical texts in only 42% of patients. However, these anatomical variations are readily identifiable. Mesh Method of fixation has also been hotly debated with varying results reported with few consistent findings of decreased long term groin pain. However, fibrin glue seems to have a slight advantage. Types of mesh have also been studied, suggesting a small advantage for lightweight over heavyweight, and for biologic mesh over synthetic. Hernia sac The role of hernia sac ligation is also being discussed. When ligation and excision of the sac is omitted, there is less reported short-term post-operative pain. However, the impact of this omission on long-term pain has not been widely studied so far.
Post herniorraphy pain syndrome
Post-vasectomy pain syndrome
Descending perineum syndrome
Urologic chronic pelvic pain syndrome
Urethral syndrome
Pelvic congestion syndrome
PELVIS syndrome
Rectovaginal fistula