Chronic pain after inguinal hernia surgery: why it happens and what robotic surgery changes

"The actor who asked to die after a hernia operation."

In September 2026, the French press reported the death of Arnaud Denis, a 43-year-old actor and theater director who chose euthanasia in Belgium after three years of pain that began right after an inguinal hernia operation. He was operated on in July 2023, with mesh, in Paris. Days later he began to feel intense pain, lost 17 kilos in three months, had the mesh removed in the United States in 2024 and did not improve. The case made the pages of major international newspapers and of Brazilian ones as well, such as Le Monde, franceinfo and Estado de Minas, and reignited a discussion that abdominal wall surgeons know well.

I did not examine Arnaud and I also had no access to his medical records, so I do not know which technique was used in his operation. For that reason, no one can claim that a different approach would have changed that patient's story. What his story does is bring into view a complication that rarely enters the conversation before surgery: the pain that does not go away.

This article explains where that pain comes from, why the surgical technique changes the risk, what robotic surgery adds and what to do when the pain is already there.

What chronic pain after inguinal hernia surgery is

Inguinal hernia repair is one of the most frequently performed operations in the world, with more than 20 million procedures a year. Most people recover within a few weeks and return to their routine without sequelae. Some patients, however, keep feeling groin pain months after surgery.

The international inguinal hernia guideline, produced by the HerniaSurge Group and endorsed by the hernia societies of the five continents, defines chronic postoperative inguinal pain as bothersome pain, of moderate intensity, that interferes with everyday activities and persists for three months or more after surgery. According to the same guideline, it occurs in 10 to 12% of patients operated on. In 0.5 to 6%, the pain is disabling, to the point of limiting work, walking and sexual life.

In other words, one in every ten people who have inguinal hernia surgery is left with some degree of persistent pain. That is a higher proportion than hernia recurrence, and even so it almost never comes up in the preoperative conversation.

Where that pain comes from

Three sensory nerves run through the groin: the ilioinguinal, the iliohypogastric and the genital branch of the genitofemoral nerve. They are structures a few millimeters thick, responsible for sensation in the groin, the upper thigh and the scrotum in men or the labia majora in women.

In conventional open surgery, known as the Lichtenstein technique, the surgeon opens the groin, works exactly in the layer where those nerves run and places the mesh over them. It is a legitimate, well-established operation that fixes the hernia. The problem is that any of those nerves can become trapped in the scar or fibrosis of the operation, in a suture, or in direct contact with the mesh. That is the most frequent cause of chronic pain: an injured, compressed or inflamed nerve.

There are other causes, such as inflammation around the mesh, staple fixation and, in rare cases, reactions to the implant material. But when a patient comes to the office with groin pain months after hernia surgery, the first suspicion is always neuropathic, that is, a suffering nerve.

Is the mesh the villain?

After the French case, many people started asking whether mesh should be avoided. The answer, based on the international guideline, is clear: mesh repair remains the first choice for most adults, because without it the hernia recurs far more often. Non-mesh techniques, such as the Shouldice repair, are indicated in selected cases and require surgeons specifically trained in them.

Reactions to the material do exist, but they are rare. In the vast majority of chronic pain cases the problem lies in the position of the mesh in relation to the nerves, and not in the material itself. That is why the surgical approach matters so much.

Open, laparoscopic and robotic surgery: what changes in the pain

In minimally invasive techniques, laparoscopic or robotic, the hernia is repaired from the inside, through three or four millimeter incisions. The mesh is placed behind the abdominal wall, in the preperitoneal space, without opening the inguinal canal and without handling the layer where the nerves run.

That difference in layer has a direct impact on pain. A systematic review with meta-analysis published in the journal Hernia in 2019, which pooled 12 randomized controlled trials and 3,966 patients, compared laparoscopic surgery with the Lichtenstein technique and found the risk of chronic pain reduced to less than half, with the same recurrence rate and less pain in the immediate postoperative period. The HerniaSurge guideline recommends minimally invasive techniques whenever a trained surgeon is available, and prefers them in women, in bilateral hernias and in recurrences after open surgery.

The same mesh, placed in a different layer, reduces the risk of chronic pain to less than half. That is the central point of this article.

What robotic surgery adds

Robotic surgery uses the same posterior approach as laparoscopy, with a fundamental difference in precision. The surgeon operates seated at a console, controlling instruments that reproduce the movements of the hands inside the abdomen, and the platform adds features that conventional laparoscopy does not offer.

The view is three-dimensional, in high definition, with up to tenfold magnification. In practice, the groin nerves, which are only a few millimeters thick, appear clearly before they are touched, and can be identified and preserved systematically.

The instruments have seven degrees of freedom and rotate like the human wrist, something the straight laparoscopic instruments do not do. This makes it possible to dissect the preperitoneal space delicately, to position a flat, wide mesh covering the whole area where inguinal and femoral hernias may arise, and to fix it with precise sutures, without staples near a nerve. It also makes it possible to close the defect of direct hernias with sutures, which reduces the risk of recurrence, and to suture the peritoneum at the end, without metal clips.

The natural tremor of the hand is filtered electronically and movements can be scaled down, which gives the surgeon a precision that does not exist in open or laparoscopic surgery.

The comparative studies point in the same direction. A meta-analysis published in the Journal of Robotic Surgery, with more than 64,000 patients, found 0% conversion to open surgery in robotic cases. A multicenter study published in the journal Surgery in 2025 showed that the learning curve of the robotic technique is shorter than that of the laparoscopic one, with 29 cases against 39, and that, once the curve was overcome, robotic operative time was shorter, 59 minutes against 65. A 2026 meta-analysis, with 5,520 patients, found chronic pain 42% lower in the robotic group compared with the laparoscopic group, a trend that the next clinical trials still need to confirm, as well as less physical strain on the surgeon over the course of the operation.

It is in the more difficult cases that this precision makes the greatest difference: recurrent hernias, large or inguinoscrotal hernias, bilateral hernias and patients who have already had prostate surgery, in whom the preperitoneal space is scarred and dissection demands maximum control.

Who operates matters more than the machine

No platform replaces the experience of the person at the console. The HerniaSurge guideline is direct on this point: the surgeon's case volume weighs more than the hospital's volume, and about 100 supervised minimally invasive operations are needed for a surgeon to achieve, through the posterior approach, the same results as the open technique. The robot shortens that curve, as the studies show, but the curve exists.

That is why the most useful question a patient can ask in consultation is how many inguinal hernias that surgeon operates per year with the proposed technique, what his chronic pain rate is and how he manages the postoperative period when the pain does not go away.

I have already been operated on and still have pain. What now?

If you had inguinal hernia surgery more than three months ago and still have groin pain, this has a name, it has treatment and it should not be accepted as normal. Chronic postoperative inguinal pain is a recognized condition, with an approach defined in the guideline.

Treatment begins with a detailed clinical assessment, to distinguish neuropathic pain, pain from hernia recurrence and other causes. From there, the guideline recommends a stepwise approach, with specific drugs for neuropathic pain, anesthetic blocks of the inguinal nerves, physical therapy and, in cases that do not respond, surgical treatment, which may include neurectomy of the three nerves and, in selected cases, removal of the mesh. These cases should be managed by a team experienced in abdominal wall surgery, preferably together with pain specialists.

How I operate inguinal hernias in Uberlândia

In my practice, inguinal hernias are repaired through the posterior approach, with the da Vinci robot, with the mesh placed behind the abdominal wall and away from the nerves. The risk of chronic pain is part of every preoperative consultation, with the figures on the table, alongside the discussion of the most appropriate technique for each case.

I practice in Uberlândia, MG, Brazil, and see patients from across the Triângulo Mineiro region. If you have an inguinal hernia and want to understand which approach makes sense for your case, or if you have already been operated on and live with pain, book an assessment.

Frequently asked questions

Is groin pain months after hernia surgery normal?

It can happen that a patient feels some occasional discomfort for months after surgery, but when we speak of pain that persists for more than three months and interferes with everyday life, that is chronic postoperative inguinal pain, a recognized complication that affects 10 to 12% of patients operated on and has treatment.

Does hernia mesh cause chronic pain?

In most cases the pain comes from a nerve trapped or irritated in the surgical area, and not from the mesh material. The position of the mesh in relation to the nerves is what weighs most. Reactions to the material do exist, but they are rare.

Is inguinal hernia surgery without mesh better?

For most adults, the international guideline recommends mesh repair, because without it the hernia recurs far more often. Non-mesh techniques are indicated in selected cases and require specific training.

What is the difference between robotic and laparoscopic inguinal hernia surgery?

Both use the posterior approach, with the mesh behind the wall. The robot adds magnified 3D vision, articulating instruments that rotate like the wrist and tremor filtering, which makes it possible to identify the nerves more clearly, to fix the mesh with sutures, without staples, and to close the hernia defect. In the studies, conversion to open surgery was zero and the learning curve was shorter.

Is robotic inguinal hernia surgery covered by health plans?

No. Robotic abdominal wall surgery is still not in the ANS mandatory list. What we can do is request the operation from the health plan through the laparoscopic route, for coverage of part of the hospital stay and of the surgical materials, but the robotic complement has to be paid privately. How the plan is used for the hospital stay and materials, and the surgical team's fees, are explained at the first consultation, case by case.

How long does recovery from robotic inguinal hernia surgery take?

In most cases discharge happens on the same day or the next day, with a return to light activities in 7 to 15 days and progressive clearance for physical exertion according to assessment in consultation.

This content is informative in nature and does not replace individual medical assessment.

Dr. Solon Gonçalves is a digestive tract surgeon (RQE 60355) and general surgeon (RQE 44656), CRM MG 79366, certified in robotic surgery by Intuitive and by Hospital Israelita Albert Einstein. He is a Professor of Surgery at the Faculty of Medicine of the Federal University of Uberlândia and practices in Uberlândia, MG, Brazil, with a focus on robotic surgery for hernias, abdominal diastasis and oncologic surgery of the digestive tract.