What is the management plan for persistent right-sided abdominal pain post Robot-Assisted Right Inguinal Hernia Repair with Mesh?

Management of Persistent Right-Sided Abdominal Pain Post Robot-Assisted Inguinal Hernia Repair

For patients experiencing persistent right-sided abdominal pain following robot-assisted inguinal hernia repair with mesh, a follow-up appointment within 1 month is recommended if pain persists, with CT imaging as the diagnostic gold standard to evaluate for potential complications.

Clinical Assessment of Post-Hernia Repair Pain

Initial Evaluation (Current Visit)

• Patient's physical examination shows:
  • Vital signs stable
  • No signs of infection at incision sites
  • No recurrent hernias appreciated on examination
  • Tolerating diet well with regular bowel movements
  • No fever, chills, nausea, vomiting, or other concerning symptoms

Potential Causes of Post-Operative Pain

• Mesh-related complications:
  • Mesh migration or displacement
  • Foreign body reaction to mesh
  • Mesh infection (though no signs present in this case)
• Nerve-related issues:
  • Nerve entrapment
  • Neuralgia from intraoperative nerve injury
• Other surgical complications:
  • Seroma formation (more common with mesh repair) 1
  • Hematoma (though less common with mesh repair) 2
  • Recurrent hernia (not detected on current examination)

Diagnostic Approach

Imaging

• CT scan of abdomen and pelvis is the gold standard for evaluating post-hernia repair complications 1, 3
• Should be performed if pain persists beyond 1 month
• Can detect:
  • Mesh displacement
  • Fluid collections (seroma, hematoma)
  • Occult recurrence not detected on physical examination
  • Other intra-abdominal pathology causing pain

Laboratory Studies

• If infection is suspected (not currently present):
  • Complete blood count
  • C-reactive protein and ESR

Management Plan

Immediate Management

• Continue current conservative approach:
  • Acetaminophen 500-1000 mg every 6 hours (maximum 4000 mg/day) as first-line pain management 3
  • Avoid NSAIDs due to increased risk of bleeding 3
  • Gradual return to regular activities over 1-2 weeks

Follow-up Plan

• Return to regular activities in 1-2 weeks as currently advised
• Schedule follow-up appointment in 1 month if pain persists
• Earlier follow-up if symptoms worsen or new symptoms develop

Patient Education

• Instruct patient to seek immediate medical attention if experiencing:
  • Severe and constant pain
  • Redness or skin changes over the surgical site
  • Nausea, vomiting, or inability to pass gas or stool
  • Fever or general malaise 3

Prognosis

• Mesh repair is associated with lower recurrence rates compared to non-mesh repairs (RR 0.46) 2
• Most post-operative pain resolves within 1-3 months
• Chronic pain occurs in approximately 5-16% of patients following inguinal hernia repair 4
• Patients with lateral inguinal hernias typically have better outcomes with lower rates of chronic pain and recurrence compared to those with medial or combined hernias 4

Special Considerations

• The type of mesh used may influence long-term outcomes:
  • Synthetic non-absorbable mesh (commonly used) may cause chronic inflammation 4
  • Long-term resorbable meshes may reduce chronic pain in some patients 4, 5
• If chronic pain persists beyond 3 months despite conservative management, additional interventions may be needed:
  • Nerve blocks
  • Mesh removal in severe cases (rare)

This management approach prioritizes patient comfort while ensuring appropriate monitoring for potential complications that could affect morbidity and mortality.