INGUINAL HERNIA REPAIR OUTCOMES AND CHRONIC POSTOPERATIVE PAIN MANAGED IN PRIMARY CARE: A SYSTEMATIC REVIEW

ABSTRACT Chronic postoperative inguinal pain represents an important complication of inguinal hernia repair, affecting recovery, daily activities, and subsequent healthcare use. This review examined long-term repair outcomes and treatment evidence relevant to assessment, follow-up, and referral in primary care. Seven primary researches published before June 2026 were synthesized narratively, encompassing three long-term randomized surgical comparisons and four randomized treatment studies. Outcomes included persistent pain, functional interference, recurrence, treatment response, and adverse effects. Surgical follow-up evidence and specialist treatment evidence were considered separately because their populations and clinical purposes differed. At five years, one randomized comparison reported chronic pain in 9.4% after totally extraperitoneal repair and 18.8% after Lichtenstein repair. Another trial found similar frequencies of non-ignorable pain between these procedures after approximately eight years. Long-term follow-up following transinguinal preperitoneal or Lichtenstein repair demonstrated substantial resolution of earlier pain. Lidocaine patches provided no significant advantage over placebo. Capsaicin patches failed to demonstrate benefit at the prespecified significance threshold. Tender-point blockade produced short-term analgesia, while tailored neurectomy achieved greater six-month treatment success than repeated injections in selected patients. Persistent pain followed heterogeneous trajectories, and treatment effectiveness depended on clinical selection and intervention. Primary care relevance centered on symptom recognition, functional assessment, medication review, and coordinated referral. Direct evidence establishing the effectiveness of a primary-care-led management pathway was absent from these seven reports. Keywords: inguinal hernia; chronic postoperative inguinal pain; herniorrhaphy; primary care; postoperative outcomes; pain management.