Chronic postoperative inguinal pain, abbreviated as CPIP, is currently the most invalidating com­plication of inguinal hernia repair and often leads to an inability to normally participate in society. It is the most costly adverse event of inguinal her­nia surgery and poses a major health issue [1, 2]. CPIP is dened by the International Association for the Study of Pain (IASP) as ‘pain beyond three months after inguinal hernia surgery’ [3]. Others have suggested to extend this period to 6 months, allowing inammatory mesh-based responses to decrease [4].

to an impairment of health status and marked lower quality of life [10–14]. Laparo-endoscopic techniques for inguinal hernia repair including TAPP and TEP may result in lower CPIP inci­dences, varying from 6 to 12.4% [9, 14].

CPIP is generally classied as neuropathic or as non-neuropathic (inammatory or nocicep­tive) pain (Fig.41.1). Neuropathic CPIP covers approximately 50–70% of CPIP, whereas the rest may be thought of as nociceptive or inamma­tory pain syndromes [15]. Proles of both neuro­pathic and non-neuropathic CPIP following laparo-endoscopic hernia repair are different compared to CPIP after open hernia repair. It must be appreciated that distinction between the two types is often difcult. Moreover, patients may present with a combination of pain charac­teristics, as CPIP can be considered as a spectrum (Fig. 41.1). To improve our understanding, the various CPIP syndromes are classied into three different entities (neuropathic, nociceptive or combined), and their associated aetiology and pathogenesis are discussed separately. Finally, pain can either be of central origin or more peripherally located. The clinical distinction of these classications is often very difcult, if not impossible.