Minimizing chronic groin pain after inguinal hernia surgery: An augmented evidence review.

BACKGROUND: Chronic post-operative inguinal pain (CPIP) is a significant complication following inguinal hernia repair. Evidence on the surgical factors associated with CPIP remains mixed and modern generations are often turning to social media and artificial intelligence (AI) tools to seek answers. The concordance between these emerging information sources and empirical evidence is yet unknown. METHODS: An augmented evidence review was performed to integrate three sources around a unifying question: "What are the key tips to minimize postoperative chronic groin pain when performing inguinal hernia repair (any approach)?" The sources compared were empiric evidence (Abdominal Core Health Quality Collaborative [ACHQC]), social media evidence on the International Hernia Collaboration [IHC] Facebook group, and Artificial Intelligence evidence from Open Evidence [OE]. RESULTS: The ACHQC analytic cohort included 4,385 patients. Laparoscopic TEP (β 0.40; p=0.032) and robotic TAPP (β 0.64; p=0.003) were associated with statistically higher 6-month pain scores compared to open repair. No significant differences in pain were observed across fixation subtypes at any time point postoperatively. Nerve identification remained statistically significant at 6-month (β 0.66 p=0.001) and 1 year postoperatively (β 0.67, p=0.01). The social media poll had 238 votes, identifying minimization of traumatic mesh fixation as the most important strategy. AI generated 16 references across surgical approach, nerve management, mesh type and fixation method. CONCLUSION: The three sources demonstrated moderate but incomplete alignment of information. As technology-driven information sources become integrated into surgical decision-making, surgeons should remain vigilant of data source shortcomings and structured frameworks evaluating concordance between these sources are essential.