Imaging Approach to Chronic Postoperative Inguinal Pain

The wide adoption of tension-free techniques and mesh used for inguinal hernia repair has shifted the focus of the postoperative period from recurrence to pain. Chronic postoperative inguinal pain (CPIP) is a potentially debilitating complication that can significantly impact an individual’s quality of life. Imaging is infrequently required for the initial inguinal hernia presentation. However, the causes of CPIP may be subtle. The challenge of managing CPIP requires surgeons to not only take a detailed history and perform a thorough physical exam but also to rely on radiologic imaging to aid in the correct diagnosis and treatment plan. The most common imaging modalities used in the evaluation of CPIP are ultrasound, computed tomography (CT), and magnetic resonance (MRI). The first test is typically an ultrasound. However, given the limitation of this modality to reliably evaluate mesh or nerve abnormalities, a negative scan should prompt further cross-sectional imaging. Importantly, the surgeon must work closely with the radiologist, and all images should be evaluated by a radiologist who specialized in groin pathology, given the user-dependent nature of these modalities.