After open inguinal hernia repair, a number of patients develop a chronic debilitating pain. The best surgical option to date appears to be groin exploration with neuronectomy and possible mesh removal.

In this video we present a 51 year old man who was operated in another hospital of inguinal hernia recurrence 2 years ago with polypropylene mesh hernioplasty. Almost immediately after surgery, the patient experienced severe pain in inguinal region. After two years of appropriate treatment, including pain clinic specialist and orthopedics consultation, the patient was referred to us. The patient suffered from constant and invalidating pain. The exploration of abdominal wall discarded hernia recurrence. The regional nerve block with local anesthesics was positive. A CT was also obtained without pathologic findings. The patient accepted reoperation after consent.

A spinal anesthesia was scheduled in ambulatory setting. A flat mesh was identified in the Lichtenstein plane. The ileohipogastric nerve was identified above the mesh in the internal oblique muscle buried into the superior part of the mesh scar. The superior part of the mesh was turned over to recognize the ileoinguinal nerve entering the scar of the mesh in the depth inguinal ring. The genital branch of genitofemoral nerve was also resected. The three nerves were resected with proximal end implantation. The mesh was partially resected. A neuroma was seen in the pathologic specimen. The patient was discharged the same day. After six months the patient remains asymptomatic.

A procedure resecting all three nerves from anterior approach may treat chronic neuralgia.