To begin, there are many causes for Post-Herniorrhaphy Pain
. As such it is difficult, if not impossible to identify the exact or probable cause without a complete and comprehensive examination and evaluation. Furthermore, in circumstances like this, it is even more difficult to 'choose' the exact surgical details for repeat surgery without some degree of flexibility. Operative findings may to a greater or lesser degree dictate some or all of the method of treatment.
Additionally, 'Alloderm' itself is not the cause of your pain. Pain, especially when it is chronic and severe in nature, is caused by entrapment or damage to nerves. This may involve one, two or all three of the nerves. More often than not, this is related to entrapment of these nerves in scar tissue, suture or even permanent mesh. The more surgical dissection, often, the more scar tissue and the higher the potential of pain. Mesh is NOT always the culprit, even though it is often implicated as the cause. Surgical skill, expertise and experience, and the ability to identify and protect these nerves during hernia repair is of paramount importance.
Effective treatment in our opinion for selected patients who are candidates for repeat remedial surgery must include a triple Neurectomy (severing all 3 nerves), as cutting only 1 or 2 nerves is too often ineffective.
With regard to your question regarding the mechanism or subsequent repair, my feeling is this. The most important thing in choosing a course for surgical management of Post-Herniorrhaphy Pain
is identifying an experienced and knowledgeable surgeon familiar with the details of this intricate procedure. It is not for the occasional hernia surgeon, but should be a specialist. Given that level of expertise, the repair of any persistent or residual hernia should be a his/her discretion based on operative findings. Micromanaging your surgeon too much can leed to poor outcomes.