Primary inguinal hernia repair is undoubtedly the most frequent surgical procedure in operating theatres worldwide.

With millions of cases treated surgically each year, it is both a serious social problem and a “market” for cutting-edge technologies.

The surgical indications and treatment of primary inguinal hernia vary greatly, depending on how advanced a country is and what economic resources it has. However, there are other factors at play, too.

The continuous succession of new technologies, prosthetic materials, devices and techniques has created a sort of melting pot that can sometimes be difficult to navigate, especially for general surgeons who only occasionally perform hernia surgery.

Although international scientific societies have developed guidelines to help clarify the choices in this field, in real life, only a minority of surgeons follow or even read them. Furthermore, although about 2 million procedures are performed every year in the world’s largest continents, the fact that scientific societies tend to have at most just a few thousand members clearly limits the potential impact of scientific recommendations. The open approach, with or without prostheses depending on the country’s level of economic development, is by far the most common treatment for primary inguinal hernia in the world as a whole (including, therefore, the most economically disadvantaged countries). Laparoscopic and, in particular, robotic approaches are used only in richer and more technologically advanced countries.

As regards the issue of surgical sequelae, the incidence of recurrences has certainly decreased greatly compared with the past, whereas that of chronic postoperative pain-related problems has increased. It is also true that the perception of postoperative symptoms has changed completely compared with the past: today’s “self-awareness”, prioritisation of quality of life, and “demand” for perfect results have led to a situation in which postoperative symptoms tend to be overestimated compared with before. And yet, if we consider the sheer volume of surgeries performed for this condition, together with the various incidence rates reported in the literature on chronic pain, there is actually cause to be optimistic. Indeed, while, as reiterated a number of times in this publication, follow-up is the Achilles’ heel of scientific evidence, meaning that the data cannot be considered 100% reliable, it is also true that scientific papers dealing with chronic pain refer to comparatively small cohorts of patients. Nevertheless, the possibility of postoperative pain should not be underestimated, and we should indeed strive to generate more correct data, both on surgical indications and “surgical” prevention of this pain, and on the adoption of an integrated approach to these situations.

This issue of Hernia includes special coverage of this topic, which is addressed by guest editors, all of whom are scientists with a particular interest in it.

The resulting topical collection will be very useful not only to the specialists who routinely deal with these situations, but also to general surgeons, who will certainly understand the importance of the aspects covered.