Many patients are referred to the North Penn Hernia Institute with chronic and/or severe pain after hernia surgery, a condition we call "Post Herniorrhaphy Pain Syndrome". Approximately 3-5% of all surgery patients develop some degree of chronic or persistent pain in the region of any surgical incision, and this can be especially bothersome after Hernia repair. Post-operative pain after hernia surgery can occur from a variety of causes and often only with the examination by a surgeon or HERNIA SPECIALIST can identify the exact cause. There are many causes for persistent pain including (but not limited to):

• Nerve damage (direct) or entrapment in scar tissue
• Post-operative benign nerve tumors (Neuromas)
• Scar Tissue itself or tissue damage
• Misplaced Mesh (if used)
• Contracted, scarified and hardened mesh plugs ("Meshomas")
• Infection (usually noted early post-op.)
• Recurrent (or Persistent) Hernia.
• Constriction of the Spermatic Cord (especially at the internal inguinal ring)
• Periostitis from improperly placed suture material
• Pain from Unrelated Causes, associated with neither the prior inguinal hernia nor its operative repair (i.e., Non-hernia musculoskeletal, Intra-abdominal, Intra-pelvic, Neurologic, Genito-urinary, Infectious or Vascular origin etc.)

The exact cause of any individual patient's pain cannot be determined of course, nor can specific treatment be recommended without an examination. Many Patients are referred to us from other surgeons and pain management physicians with persistent post operative pain following hernia surgery. We often recommend conservative measures, especially in cases where the pain is not to severe. These treatment methods include:

• Physical Therapy Activity
• Local Injection
• Anti-inflammatory Pain Medication

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Often in cases where the above treatment options have been unsuccessfully utilized, and only in severe, debilitating or persistent cases of pain, lasting more than 1 year, repeat operation is offered in hopes of improving the status of the patients. We attempt to identify the cause at surgery, and correct the problem based on the findings. At this time we also reconstruct the inguinal canal to our specifications for post operative hernia repair. But no accurate diagnosis can be made without an examination and/or surgical re-exploration.

To be considered for surgery at NPHI for severe and/or debilitating chronic Post-Herniorrhaphy Pain Syndrome, patients must:

• Provide Operative Reports of all prior inguinal hernia surgery in that area.
• Be acceptable candidates for General Anesthesia.
• Be at least one (1) full year since any prior Inguinal Hernia Surgery.
• Be not more than 15% above Ideal Body Weight.
• Have not had prior pain-related only surgery on that area in the past.
• Have documented trials of both Pain Management and Physical Therapy without significant relieve or pain resolution.

Repeat surgery, regardless of the cause of the pain or its intensity, is not always completely successful in alleviating the pain entirely. Reasonable expectations achieved by such repeat operation in patients referred to us with severe or debilitating post-operative "POST-HERNIORRHAPHY PAIN SYNDROME" are as follows:

• 50% Only are completely or nearly completely Pain-Free (Patients no longer disabled, and require no regular pain medication)
• 20-25%- Some Residual Pain (Moderate to Severe) but patients may be somewhat improved (Patient may be normally functioning, however some medication still necessary)
• 15020%- No Change noted after Repeat Surgery (Patients feel about the same as before surgery..continues to use analgesics medication)
• 5-10%- Pain may be worse (may require long term narcotic use, and may be more debilitated).
  

The recovery period after this operation is longer than that following a routine hernia reapir, and may require 4-6 weeks of recuperation or longer.



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In some cases, while the pain may or may not have been relieved, an area of numbness or loss of sensation of the skin, both in the region of the surgery, and potentially extending towards the genitalia and towards the leg, may occur after such repeat surgery for post operative pain. This numbness may be permanent or temporary, mild or profound.

I have read the above full statement carefully and understand fully the nature of my problem, and implications, expectations and risks of surgery. I have been given full opportunity to ask questions and they have been answered to my satisfaction.

_________________________________________ Date______________
PATIENT SIGNATURE

__________________________________________ Date_______________
WITTNESS









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