Chronic groin pain following hernia surgery is defined as pain that lasts for more than 3 months and documented among 18% of post herniorrhaphy patients. Severe intractable pain can occur in about 1-5% of patients. The causes of chronic post herniorrhaphy groin pain can be neuropathic or non-neuropathic.

A 54-year-old man presented with a two-and-a-half-year history of intractable left sided groin pain following left recurrent inguinal hernia repair with mesh in 2019. The patient reported experiencing severe pain in his left groin which radiates into scrotum. There was no clinically demonstrable recurrence or radiologically demonstrable meshoma in the ultrasound scan of the groin. He was treated with oral analgesics (NSAID, Opiate & TCA). These medications provided only mild relief to his pain. He was then treated with image guided nerve block, which provided relief only for a short period. So, we planned surgery as a last option and offered a laparoscopic retro-peritoneal triple neurectomy. Laparoscopic triple neurectomy was done with identification and transection of the ilioinguinal, iliohypogastric, and genitofemoral nerves.

Laparoscopic retro peritoneal triple neurectomy is safe and appropriately provides relief to the chronic intractable groin pain. Since there is no available literature regarding this procedure up to now in Sri Lanka, we assume this may be the first reported case in Sri Lankan surgical literature.