Background: Chronic postoperative inguinal pain [CPIP] is a prevalent and often debilitating complication following inguinal hernia repair. With the widespread adoption of mesh-based techniques, recurrence rates have significantly declined, shifting clinical focus toward postoperative pain management. Methods: This narrative review synthesizes international literature on CPIP incidence, surgical technique, geographic variation, and the distinction between neuropathic and nociceptive pain. Studies were selected based on relevance, sample size, and inclusion of pain subclassification. Results: CPIP incidence varies markedly across studies (6–64.3%), influenced by follow-up duration, surgical approach, and regional healthcare practices. The risk of CPIP varies significantly, depending on the surgical technique employed, with open repairs generally associated with higher rates than laparoscopic approaches. Neuropathic pain predominates in specific cohorts, particularly following open repairs with limited nerve preservation. Few studies differentiate pain types, revealing a critical gap in diagnostic precision. Conclusions: CPIP is a multifactorial and under-recognized problem in clinical practice. The adoption of standardized diagnostic tools and long-term follow-up protocols is essential to improve pain classification and management. A structured diagnostic algorithm may assist clinicians in distinguishing pain types and tailoring treatment strategies to individual patient profiles.

Matteo Matteucci, Maria Chiara Ranucci, Salvatore Guarino, Bruno Cirillo, Luca Properzi, Justin Davies, Pietro Ursi, Vito D’Andrea, Roberto Cirocchi. Ann Hepatobiliary Pancreat Surg -0001;0:. https://doi.org/10.14701/ahbps.25-068

Background: Chronic postoperative inguinal pain [CPIP] is a prevalent and often debili-tating complication following inguinal hernia repair. With the widespread adoption of mesh-based techniques, recurrence rates have declined, shifting clinical focus toward postoperative pain management. Methods: This narrative review synthesizes international literature on CPIP incidence, surgical technique, geographic variation, and the distinction between neuropathic and nociceptive pain. Studies were selected according to relevance, sample size, and inclusion of pain subclassification. Results: CPIP incidence varies widely across studies (6%–64.3%), as it is influenced by follow-up duration, surgical approach, and regional healthcare practices. Laparoscopic techniques generally yield lower CPIP rates, though exceptions exist. Neuropathic pain predominates in certain cohorts, particularly following open repairs with limited nerve preservation. Few studies differentiate pain types, revealing a gap in diagnostic rigor. Conclusions: CPIP is a multifactorial and underrecognized problem in clinical practice. Standardized diagnostic tools and long-term follow-up are essential to improve classifica-tion and management. A structured algorithm may aid clinicians in distinguishing pain types and tailoring treatment strategies.

Background: The treatment of the primary tumour in colorectal cancer with unresectable liver and/or lung metastases but no peritoneal carcinomatosis is still a matter of debate. In the absence of clear evidence and guidelines, our survey was aimed at obtaining a snapshot of the current attitudes and the rationales for the choice of offering resection of the primary tumour (RPT) despite the presence of untreatable metastases. Methods: An online survey was administered to medical professionals worldwide. The survey had three sections: (1) demographics of the respondent, (2) case scenarios and (3) general questions. For each respondent, an “elective resection score” and an “emergency resection score” were calculated as a percentage of the times he or she would offer RPT in the elective and in the emergency case scenarios. They were correlated to independent variables such as age, type of affiliation and specific workload. Results: Most respondents would offer palliative chemotherapy as the first choice in elective scenarios, while a more aggressive approach with RPT would be reserved for younger patients with good performance status and in emergency situations. Respondents younger than 50 years old and those with a specific workload of fewer than 40 cases of colorectal cancer per year tend to be more conservative. Conclusions: In the absence of clear guidelines and evidence, there is a lack of consensus on the treatment of the primary tumour in case of colon cancer with unresectable liver and/or lung metastases and no peritoneal carcinomatosis. Palliative chemotherapy seems to be the first option, but more consistent evidence is needed to guide this choice.