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

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.

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.

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).

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.