Minimizing chronic groin pain after inguinal hernia surgery: an augmented evidence review

Chronic postoperative inguinal pain (CPIP) is a significant complication after inguinal hernia repair. Evidence on the surgical factors associated with CPIP remains mixed, and modern generations are often turning to social media and artificial intelligence (AI) tools to seek answers. The concordance between these emerging information sources and empirical evidence remains unknown.

An augmented evidence review was performed to integrate 3 sources addressing a unifying question: "What are the key tips to minimize postoperative chronic groin pain when performing inguinal hernia repair (any approach)?" The sources compared were empirical evidence from the Abdominal Core Health Quality Collaborative (ACHQC), social media evidence on the International Hernia Collaboration Facebook group, and AI evidence from OpenEvidence.

The ACHQC analytic cohort included 4385 patients. Laparoscopic totally extraperitoneal repair (β, 0.40; P =.032) and robotic transabdominal preperitoneal repair (β, 0.64; P =.003) were associated with statistically higher 6-month pain scores compared with open repair. No significant differences in pain were observed across fixation subtypes at any timepoint postoperatively. In contrast, nerve identification remained statistically significant at 6 months (β, 0.66; P =.001) and 1 year (β, 0.67; P =.01) postoperatively. The social media poll received 238 votes, with respondents identifying minimization of traumatic mesh fixation as the most important strategy. AI generated 16 references across surgical approach, nerve management, mesh type, and fixation method.

The 3 sources demonstrated moderate but incomplete alignment of information. As technology-driven information sources become increasingly integrated into surgical decision-making, surgeons should remain vigilant regarding the shortcomings of each data source, and structured frameworks to evaluate concordance among these sources are essential.