Chronic pain is a complication after inguinal hernia repair that can manifest itself as a serious impact on the patient’s quality of life and can be a trigger for doctor-patient conflict. Therefore, it needs to be treated and managed seriously. In fact, looking at it from a higher standpoint, injury and pain are something that human beings have to experience throughout their lives; what would the world be without pain? Philosophically speaking, pain is a kind of wisdom; legally speaking pain is a kind of reward; religiously speaking, pain is a kind of salvation; medically speaking, pain is then a preview of injury or illness. It is conceivable that appendicitis without abdominal pain is a terrible thing. Chronic pain after inguinal hernia surgery is characterized by three major symptoms: somatic pain, neuropathic pain and visceral pain. 1. Somatic pain. It is the most common type of chronic pain, usually located in the area from the inguinal ligament to the pubic symphysis, and manifests as pain when moving or when pressing on the abdominal wall. Since the pubic tuberosity periosteum is rich in nerve fibers and is extremely sensitive, damage to the pubic tuberosity periosteum when fixing the mesh can produce local pain. 2.Neuralgia. It is commonly caused by injury to the ilioinguinal nerve or genitofemoral nerve. The pain is usually located in the area innervated by the damaged nerve and is sharp and electric shock-like pain. Partial or complete dissection of the nerve during surgery, traction, contusion, compression, and suturing of the nerve can all cause neuralgia. Secondly, irritation and compression during the inflammatory proliferation of adjacent granuloma tissue can also cause neuralgia. 3. Visceral pain. The main manifestation is ejaculation pain. It may be caused by damage to the somatic sacral nerve or sympathetic nerve, and smooth muscle dysfunction of the vas deferens. Tissue scarring of the vas deferens stenosis or torsion of the spermatic cord may also be another cause of ejaculatory pain. In addition to the above-mentioned causes, there are reports in the literature that excessive mesh plugging, intra-incisional hematoma formation and compression of the spermatic cord or vascular injury may all contribute to chronic pain. There are many factors that influence postoperative pain after hernia repair, usually divided into two categories: patient factors and surgical factors. Patients who are young, obese, have a history of preoperative pain, have a stable occupation, and have health insurance are more likely to have chronic postoperative pain. A regression analysis found that patients aged <40 years with an occupation (full-time) were more likely to have chronic pain, and that patients with preoperative pain had a greater tendency to have postoperative pain. Surgical factors, open surgical repair, use of patches, injury to the nerve, intentional severance of the nerve, postoperative infection or hematoma, quality of the patch, quality of the patch, and chronic unherniated recurrence were all common factors contributing to chronic pain. A study found that 22%, 24%, and 15% of patients in the Shouldice ( n = 94) , Lichtenstein ( n = 94) , and TAPP ( n = 94) procedures, respectively, experienced mild discomfort and pain, and 13%, 5%, and 1% of patients, respectively, experienced moderate intensity pain. In the Shouldice and Lichtenstein group, 3% had severe pain, but none in the TAPP patients. The management and treatment of chronic pain after inguinal hernia surgery 1. observation and waiting: some patients with early postoperative pain can have their pain relieved or disappeared after 2 months of observation. If the symptoms are not relieved or worsened, further treatment is needed. 2.Physical therapy: Acupuncture is a major tool. Acupuncture can stimulate the secretion of endogenous opioid-like substances, which is simple and economical. Nerve block: including local anesthesia and peripheral nerve block. Local anesthesia is simple and easy to administer, but may lead to an increased recurrence rate of herniation. Peripheral nerve block is more effective than local anesthesia in treating short-term pain, but there is a lack of follow-up studies on long-term effects. 3.Medication: Combination of antidepressants and weak opioid analgesics, such as amitriptyline and tramadol. Opioid analgesics are only used as a last resort. 4.Surgical treatment: including neurolysis or neurectomy, but the therapeutic effect is still controversial. Nerve release is indicated for nerve compression rather than injury, but is less effective in patients with chronic pain. Neurotomy of the genitofemoral nerve often involves the removal of part of the ilioinguinal nerve, resulting in decreased sensation in the skin of the labia majora and femoral triangle and loss of the testicular reflex. Heise et al. performed surgical treatment of chronic pain after open or laparoscopic hernia repair in 20 patients. 4 patients had only the patch removed, and the remaining 16 patients had the patch removed in combination with iliogastroinguinal nerve and inferior iliac abdominal nerve resection. 60% of patients had some relief of pain. Prevention of chronic pain after inguinal hernia surgery Skilled surgical technique and adequate knowledge of anatomy are essential to avoid nerve injury. The inguinal nerve, inferior iliac nerve, and genitofemoral branch should be carefully identified and protected during surgery to avoid excessive stretching, injury, or suturing. The patch should be placed at a certain distance from the nerve or buried in the muscle. Excessive tension between the inguinal ligament and the pubic symphysis should be avoided. Fixation of the mesh with its own intra-abdominal pressure to avoid suture fixation can greatly reduce nerve pain. The surgical approach is another important aspect of pain prevention. Laparoscopic hernia repair has a lower incidence of chronic pain than open surgery, with TAPP having a higher incidence of chronic pain in the laparoscopic technique. Although mesh repair is more advantageous than repair without mesh, it must be clearly recognized that the fixation of the mesh (including sutures) is a major cause of neuropathic pain and that fixation of the mesh with various fixation staples to prevent nerve compression should be minimized or avoided.