Incidence of prolonged postoperative pain after open inguinal hernia repair is somewhere in the region of 30% and of these, 10% will experience pain severe enough to disturb everyday life (Franneby et al 2006, Franneby et al 2008). In the 2006 study, there was no difference in reported pain after mesh repair compared with non-mesh techniques although there have been other publications suggesting an increased risk of pain after mesh repair.
The reason mesh (and specifically, the Lichtenstein method which is the most commonly used method today) has become very popular is that compared with other techniques, the rates of recurrence are lower and the learning-curve of the operating surgeon is comparatively short. This is not a construct based on marketing by medical device companies that manufacture the meshes, but based on large epidemiological studies looking at hernia recurrence after surgery.
For bilateral hernias, the generally accepted approach is now to perform a laparoscopic (keyhole) repair (total extraperitoneal repair, TEP) with mesh insertion. There have been numerous studies assessing the outcomes after open versus laparoscopic procedures; one of the most recent was published last year where just under 200 patients were randomised to either Lichtenstein repair under local anaesthesia or TEP. 6 weeks post surgery, the TEP group reported significantly less pain interfering with daily activities (6/191 vs 16/187, P<0.05) (Dahlstrand et al 2013).
So in summary, there is no firm evidence that completely supports or dispels the notion that mesh repair increases the risk of groin pain after hernia repair. Laparoscopic repair is currently preferrable for patients presenting with bilateral or recurrent hernias after previous open surgery and
may be associated with reduced postoperative pain compared with open repair.
If you're being assessed for hernia repair, make sure this is done at a high volume center, especially if you're being offered laparoscopic repair, as there's a steep learning curve for TEP.
Good luck!
