Prevention of pain: optimizing the open primary inguinal hernia repair technique

The prevention of pain requires that surgeons should take care not only during the entire surgical procedure but also before and after, following these steps:
1. Preoperative patient selection: preoperative pain, preoperative pain response to heat, intraoperative nerve injury, early postoperative pain intensity, younger age, and open surgery are risk factors for postoperative chronic pain.
2. Anesthesia: local anesthesia seems to be followed by less postoperative pain.
3. Approach: open anterior for all primary inguinal hernias.
4. Identification and respect of the three nerves when possible, otherwise pragmatic neurectomy.
5. Choice of the prosthesis: light- or medium-weight polypropylene flat mesh for “normal” patients.
6. Choice of fixation: sutureless or fibrin glue fixation should be advised.
7. Always provide proper postoperative therapy.