Laparoscopic mesh removal in inguinal hernia surgery: evaluating patient satisfaction and surgical outcomes.

Abstract

<h4>Purpose</h4>This study aimed to evaluate the safety and efficacy of laparoscopic preperitoneal mesh removal approach for managing chronic postoperative inguinal pain (CPIP) and recurrent inguinal hernia.<h4>Methods</h4>This retrospective cohort study included 32 consecutive patients who presented with chronic postoperative inguinal pain (CPIP) and/or recurrent inguinal hernia between May 2013 and December 2024 following laparoscopic inguinal hernia repair performed at external instutions. All patients underwent preoperative evaluation with ultrasound and/or 1.5-Tesla MRI to assess mesh-related complications such as meshoma, migration, or inadequate coverage. 23 patients underwent concurrent laparoscopic hernia repair; redo transabdominal preperitoneal (TAPP) was performed in 21 and redo totally extraperitoneal (TEP) in 2. In 9 patients, no evidence of hernia was identified intraoperatively during mesh removal; therefore, secondary hernia repair was not undertaken. Pre- and postoperative questionnaires (the Brief Pain Inventory (BPI) and Short Form Inguinal Pain Questionnaire (sf-IPQ)) on pain and quality of life (QoL) scores were recorded.<h4>Results</h4>32 patients (median age 43 years; 84% male) underwent laparoscopic mesh removal, with a total of 41 meshes explanted. Bilateral mesh removal was performed in 28% of cases, and simultaneous laparoscopic hernia repair was carried out in 72% of patients. The median operative time was 123 min, and no conversions to open surgery occured. Intraoperative complications were observed in 19% of patient, including inferior epigastric artery injury (9%), vas deference injury /6%), and bladder injury (3%). Postoperative complications were minimal (13%) and included testicular tenderness, seroma, surgical site infection, and one recurrence. At a median follow-up of 8.5 months (2-139 months), 59% of patients reported complete pain relief and 34% partial improvement, with significant reductions in both Sf-IPQ and BPI scores (p < 0.001).<h4>Conclusions</h4>Laparoscopic preperitoneal mesh removal was associated with high rates of technical success and acceptable safety profile; however, due to its technical complexity, the procedure should be limited to experienced surgeons in specialized centers. Patient satisfaction and quality-of-life scores showed significant improvement following the intervention. Laparoscopic mesh removal represents a feasible option for the management of chronic postoperative inguinal pain (CPIP) and/or recurrent inguinal hernias, and successful treatment of CPIP can result in substantial enhancement of patients' quality of life.