Skip to main content
SpringerLink
Log in

Evidence-based assessment of the period of physical inactivity required after inguinal herniotomy

  • Review Article
  • Published:
Langenbeck's Archives of Surgery Aims and scope Submit manuscript

Abstract

Purpose

Since herniotomy is one of the most frequent surgical procedures, the socioeconomical impact of guidelines for convalescence is substantial; at the same time, the introduction of mesh techniques as standard procedure has led to a marked decrease in recurrence rates. Therefore, a reappraisal of guidelines concerning convalescence is warranted.

Methods

This study is a comprehensive review of the literature including all levels of evidence.

Results

If an inguinal hernia is repaired with an appropriate technique in a surgically and technically faultless contemporary procedure, it is fully stable immediately after surgery. Therefore, pain is the only rational limiting factor for physical activities after the intervention. If a patient wishes to go back to work or other activities early, there is no reason to not facilitate this via a generous prescription of analgesics. Even hard physical work can technically be resumed after complete healing of the skin wound, and prolonged sick leave is neither necessary nor beneficial. No interrelation between physical activity after herniotomy and recurrence rate has yet been demonstrated; a randomized controlled trial might finally clarify this question, but at a substantial effort.

Conclusions

The periods of inactivity practiced by patients and recommended by GPs are widely arbitrary and basically much too long, leading to unnecessary expenditures with an estimated order of magnitude of several hundred million € per year in Germany. To reduce this surplus, guidelines should be implemented by the surgical professional associations and communicated intensively towards GPs and patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Holzheimer RG (2004) First results of Lichtenstein hernia repair with Ultrapro®-mesh as cost saving procedure—quality control combined with a modified quality of life questionnaire (SF-36) in a series of ambulatory operated patients. Eur J Med Res 9(6):323–327

    PubMed  Google Scholar 

  2. Holzheimer RG (2005) Inguinal hernia: classification, diagnosis and treatment—classic, traumatic and Sportsman's hernia. Eur J Med Res 10(3):121–134

    PubMed  Google Scholar 

  3. Kurzer M, Kark A, Hussain T (2007) Inguinal hernia repair. J Perioper Pract 17 (7):318–321, 323–316, 328–330

    Google Scholar 

  4. Schumpelick V, Stumpf M, Schwab R (2004) Leistenhernienchirurgie als ambulante und kurzzeitstationäre Chirurgie. Möglichkeiten und Grenzen. Chirurg 75(2):126–130. doi:10.1007/s00104-003-0777-5

    Article  PubMed  CAS  Google Scholar 

  5. Prieto-Díaz-Chávez E, Medina-Chávez JL, Anaya-Prado R (2009) A cost-effectiveness analysis of tension-free versus shouldice inguinal hernia repair: a randomized double-blind clinical trial. Hernia 13(3):233–238. doi:10.1007/s10029-008-0461-2

    Article  PubMed  Google Scholar 

  6. Gholghesaei M, Langeveld HR, Veldkamp R, Bonjer HJ (2005) Costs and quality of life after endoscopic repair of inguinal hernia vs open tension-free repair: a review. Surg Endosc 19(6):816–821. doi:10.1007/s00464-004-8949-z

    Article  PubMed  CAS  Google Scholar 

  7. Kuhry E, van Veen RN, Langeveld HR, Steyerberg EW, Jeekel J, Bonjer HJ (2007) Open or endoscopic total extraperitoneal inguinal hernia repair? A systematic review. Surg Endosc 21(2):161–166. doi:10.1007/s00464-006-0167-4

    Article  PubMed  CAS  Google Scholar 

  8. Subhas G, Bakston D, Gupta A, Jacobs MJ, Mittal VK, Silapaswan S (2010) Internal ring occlusion and floor support: a novel technique for inguinal hernia mesh repair. Am Surg 76(9):933–937

    PubMed  Google Scholar 

  9. Simons MP, Aufenacker T, Bay-Nielsen M, Bouillot JL, Campanelli G, Conze J, de Lange D, Fortelny R, Heikkinen T, Kingsnorth A, Kukleta J, Morales-Conde S, Nordin P, Schumpelick V, Smedberg S, Smietanski M, Weber G, Miserez M (2009) European Hernia Society guidelines on the treatment of inguinal hernia in adult patients. Hernia 13(4):343–403. doi:10.1007/s10029-009-0529-7

    Article  PubMed  CAS  Google Scholar 

  10. Bittner R, Arregui ME, Bisgaard T, Dudai M, Ferzli GS, Fitzgibbons RJ, Fortelny RH, Klinge U, Kockerling F, Kuhry E, Kukleta J, Lomanto D, Misra MC, Montgomery A, Morales-Conde S, Reinpold W, Rosenberg J, Sauerland S, Schug-Pass C, Singh K, Timoney M, Weyhe D, Chowbey P (2011) Guidelines for laparoscopic (TAPP) and endoscopic (TEP) treatment of inguinal hernia [International Endohernia Society (IEHS)]. Surg Endosc 25(9):2773–2843. doi:10.1007/s00464-011-1799-6

    Article  PubMed  CAS  Google Scholar 

  11. Aasvang EK, Gmaehle E, Hansen JB, Gmaehle B, Forman JL, Schwarz J, Bittner R, Kehlet H (2010) Predictive risk factors for persistent postherniotomy pain. Anesthesiology 112(4):957–969. doi:10.1097/ALN.0b013e3181d31ff8

    Article  PubMed  Google Scholar 

  12. Schmedt CG, Sauerland S, Bittner R (2005) Comparison of endoscopic procedures vs Lichtenstein and other open mesh techniques for inguinal hernia repair: a meta-analysis of randomized controlled trials. Surg Endosc 19(2):188–199. doi:10.1007/s00464-004-9126-0

    Article  PubMed  CAS  Google Scholar 

  13. Reuben B, Neumayer L (2006) Surgical management of inguinal hernia. Adv Surg 40:299–317

    Article  PubMed  Google Scholar 

  14. Alkhoury F, Martin JT, Contessa J, Zuckerman R, Nadzam G (2010) The impact of laparoscopy on the volume of open cases in general surgery training. J Surg Educ 67(5):316–319. doi:10.1016/j.jsurg.2010.08.001

    Article  PubMed  Google Scholar 

  15. Eklund AS, Montgomery AK, Rasmussen IC, Sandbue RP, Bergkvist LA, Rudberg CR (2009) Low recurrence rate after laparoscopic (TEP) and open (Lichtenstein) inguinal hernia repair: a randomized, multicenter trial with 5-year follow-up. Ann Surg 249(1):33–38. doi:10.1097/SLA.0b013e31819255d0

    Article  PubMed  Google Scholar 

  16. Nyhus LM (1989) The recurrent groin hernia: therapeutic solutions. World J Surg 13(5):541–544

    Article  PubMed  CAS  Google Scholar 

  17. Hendry PO, Paterson-Brown S, de Beaux A (2008) Work related aspects of inguinal hernia: a literature review. Surgeon 6(6):361–365

    Article  PubMed  CAS  Google Scholar 

  18. McIntosh A, Hutchinson A, Roberts A, Withers H (2000) Evidence-based management of groin hernia in primary care—a systematic review. Fam Pract 17(5):442–447

    Article  PubMed  CAS  Google Scholar 

  19. Bay-Nielsen M, Bisgaard T (2009) Rekonvalescens og sygemelding efter operation for lyskebrok. [Convalescence and sick leave following inguinal hernia repair]. Ugeskr Laeger 171(40):2899–2901

    PubMed  Google Scholar 

  20. Lucht M (2008) Gesicherte Erkenntnisse zur Notwendigkeit einer körperlichen Schonung nach Leistenhernienoperation—Eine Evidenzbasierte Literaturstudie. Doctoral Thesis, Johann Wolfgang Goethe-Universität, Frankfurt/Main

  21. Kavic MS (2005) Hernia repair: 2005. A reflection. Hernia 9(4):308–309. doi:10.1007/s10029-005-0001-2

    Article  PubMed  Google Scholar 

  22. McCormack K, Wake B, Perez J, Fraser C, Cook J, McIntosh E, Vale L, Grant A (2005) Laparoscopic surgery for inguinal hernia repair: systematic review of effectiveness and economic evaluation. Health Technol Assess 9(14):1–203, Ii–iv

    PubMed  CAS  Google Scholar 

  23. Bourke JB, Taylor M (1978) The clinical and economic effects of early return to work after elective inguinal hernia repair. Br J Surg 65(10):728–731

    Article  PubMed  CAS  Google Scholar 

  24. Bourke JB, Lear PA, Taylor M (1981) Effect of early return to work after elective repair of inguinal hernia: clinical and financial consequences at one year and three years. Lancet 2(8247):623–625

    Article  PubMed  CAS  Google Scholar 

  25. Taylor EW, Dewar EP (1983) Early return to work after repair of a unilateral inguinal hernia. Br J Surg 70(10):599–600

    Article  PubMed  CAS  Google Scholar 

  26. Baker DM, Rider MA, Locker A, Fawcett AN (1993) How long do patients convalesce after inguinal herniorrhaphy? Current principles and practice. Ann R Coll Surg Engl 75(3):216

    PubMed  CAS  Google Scholar 

  27. Baker DM, Rider MA, Fawcett AN (1994) When to return to work following a routine inguinal hernia repair: are doctors giving the correct advice? J R Coll Surg Edinb 39(1):31–33

    PubMed  CAS  Google Scholar 

  28. Thorup J, Jørgensen T, Kjaergaard J, Billesbølle P (1994) Convalescence after inguinal herniorrhaphy. Scand J Gastroenterol 29(12):1150–1152

    Article  PubMed  CAS  Google Scholar 

  29. Bay-Nielsen M, Thomsen H, Andersen FH, Bendix JH, Sørensen OK, Skovgaard N, Kehlet H (2004) Convalescence after inguinal herniorrhaphy. Br J Surg 91(3):362–367. doi:10.1002/bjs.4437[doi]

    Article  PubMed  CAS  Google Scholar 

  30. Blodgett JB, Beattie EJ (1947) The effect of early postoperative rising on the recurrence rate of hernia. Surg Gynecol Obstet 84:716–718

    PubMed  CAS  Google Scholar 

  31. Salcedo-Wasicek MC, Thirlby RC (1995) Postoperative course after inguinal herniorrhaphy. A case-controlled comparison of patients receiving workers' compensation vs patients with commercial insurance. Arch Surg 130(1):29–32

    Article  PubMed  CAS  Google Scholar 

  32. Chiofalo R, Holzinger F, Klaiber C (2001) Total endoskopische präperitoneale Netzplastik bei primären und Rezidivleistenhernien. Gibt es Unterschiede? Chirurg 72(12):1485–1491

    Article  PubMed  CAS  Google Scholar 

  33. Savarise MT, Simpson JP, Moore JM, Leis VM (2001) Improved functional outcome and more rapid return to normal activity following laparoscopic hernia repair. Surg Endosc 15(6):574–578. doi:10.1007/s004640080039[doi]

    Article  PubMed  CAS  Google Scholar 

  34. Pavlidis TE, Atmatzidis KS, Lazaridis CN, Papaziogas BT, Makris JG, Papaziogas TB (2002) Comparison between modern mesh and conventional non-mesh methods of inguinal hernia repair. Minerva Chir 57(1):7–12

    PubMed  CAS  Google Scholar 

  35. Amid PK, Lichtenstein IL (1998) Long-term result and current status of the Lichtenstein open tension-free hernioplasty. Hernia 2:89–94

    Article  Google Scholar 

  36. Quilici PJ, Greaney EM Jr, Quilici J, Anderson S (2000) Laparoscopic inguinal hernia repair: optimal technical variations and results in 1700 cases. Am Surg 66(9):848–852

    PubMed  CAS  Google Scholar 

  37. Robertson GS, Burton PR, Haynes IG (1993) How long do patients convalescence after inguinal herniorrhaphy? Current principles and practice. Ann R Coll Surg Engl 75(1):30–33

    PubMed  CAS  Google Scholar 

  38. Töns C, Muck-Töns A, Schumpelick V (1993) Leistenhernienchirurgie in Deutschland 1992: Eine Umfrage an 1656 deutschen Kliniken. Chirurg 64(8):635–641

    PubMed  Google Scholar 

  39. Bachoo P, Duncan JL (1995) Prolonged convalescence following inguinal hernia repair: an unnecessary trend. Health Bull (Edinb) 53(4):209–212

    CAS  Google Scholar 

  40. Herzog U, Kocher T (1996) Leistenhernienchirurgie in der Schweiz 1994. Eine Umfrage an 142 Ausbildungskliniken in der Schweiz. Chirurg 67(9):921–926

    Article  PubMed  CAS  Google Scholar 

  41. van den Oever R, Debbaut B (1996) Kostenanalyse der Leistenhernienchirurgie bei ambulanter und stationärer Versorgung. Zentralbl Chir 121(10):836–840

    PubMed  Google Scholar 

  42. Ciampolini J, Boyce DE, Shandall AA (1998) Adult hernia surgery in Wales revisited: impact of the guidelines of The Royal College of Surgeons of England. Ann R Coll Surg Engl 80(5):335–338

    PubMed  CAS  Google Scholar 

  43. Kehlet H, Callesen T (1998) Recommendations for convalescence after hernia surgery. A questionnaire study. Ugeskr Laeger 160(7):1008–1009

    PubMed  CAS  Google Scholar 

  44. Ismail W, Taylor SJ, Beddow E (2000) Advice on driving after groin hernia surgery in the United Kingdom: questionnaire survey. BMJ 321(7268):1056

    Article  PubMed  CAS  Google Scholar 

  45. Metzger J, Lutz N, Laidlaw I (2001) Guidelines for inguinal hernia repair in everyday practice. Ann R Coll Surg Engl 83(3):209–214

    PubMed  CAS  Google Scholar 

  46. Rider MA, Baker DM, Locker A, Fawcett AN (1993) Return to work after inguinal hernia repair. Br J Surg 80(6):745–746

    Article  PubMed  CAS  Google Scholar 

  47. Callesen T, Klarskov B, Bech K, Kehlet H (1999) Short convalescence after inguinal herniorrhaphy with standardised recommendations: duration and reasons for delayed return to work. Eur J Surg 165(3):236–241. doi:10.1080/110241599750007108[doi]

    Article  PubMed  CAS  Google Scholar 

  48. Bay-Nielsen M, Perkins FM, Kehlet H (2001) Pain and functional impairment 1 year after inguinal herniorrhaphy: a nationwide questionnaire study. Ann Surg 233(1):1–7

    Article  PubMed  CAS  Google Scholar 

  49. Kumar S, Wilson RG, Nixon SJ, Macintyre IM (2002) Chronic pain after laparoscopic and open mesh repair of groin hernia. Br J Surg 89(11):1476–1479. doi:10.1046/j.1365-2168.2002.02260.x

    Article  PubMed  CAS  Google Scholar 

  50. Sajid MS, Leaver C, Baig MK, Sains P (2012) Systematic review and meta-analysis of the use of lightweight versus heavyweight mesh in open inguinal hernia repair. Br J Surg 99(1):29–37. doi:10.1002/bjs.7718

    Article  PubMed  CAS  Google Scholar 

  51. Kluivers KB, Hendriks JC, Mol BW, Bongers MY, Bremer GL, de Vet HC, Vierhout ME, Brolmann HA (2007) Quality of life and surgical outcome after total laparoscopic hysterectomy versus total abdominal hysterectomy for benign disease: a randomized, controlled trial. J Minim Invasive Gynecol 14(2):145–152. doi:10.1016/j.jmig.2006.08.009

    Article  PubMed  Google Scholar 

  52. Korolija D, Sauerland S, Wood-Dauphinee S, Abbou CC, Eypasch E, Caballero MG, Lumsden MA, Millat B, Monson JR, Nilsson G, Pointner R, Schwenk W, Shamiyeh A, Szold A, Targarona E, Ure B, Neugebauer E (2004) Evaluation of quality of life after laparoscopic surgery: evidence-based guidelines of the European Association for Endoscopic Surgery. Surg Endosc 18(6):879–897. doi:10.1007/s00464-003-9263-x

    Article  PubMed  CAS  Google Scholar 

  53. Le Blanc-Louvry I, Coquerel A, Koning E, Maillot C, Ducrotté P (2000) Operative stress response is reduced after laparoscopic compared to open cholecystectomy: the relationship with postoperative pain and ileus. Dig Dis Sci 45(9):1703–1713

    Article  PubMed  Google Scholar 

  54. McLauchlan GJ, Macintyre IM (1995) Return to work after laparoscopic cholecystectomy. Br J Surg 82(2):239–241

    Article  PubMed  CAS  Google Scholar 

  55. Ottesen M, Møller C, Kehlet H, Ottesen B (2001) Substantial variability in postoperative treatment, and convalescence recommendations following vaginal repair. A nationwide questionnaire study. Acta Obstet Gynecol Scand 80(11):1062–1068

    PubMed  CAS  Google Scholar 

  56. Bokobza B (2002) Causes and mechanisms of recurrence after laparoscopic ventral hernia repair. In: Morales-Conde S (ed) Laparoscopic ventral hernia repair. Springer-Verlag, France, pp 451–461

    Google Scholar 

  57. Wara P, Bay-Nielsen M, Juul P, Bendix J, Kehlet H (2005) Prospective nationwide analysis of laparoscopic versus Lichtenstein repair of inguinal hernia. Br J Surg 92(10):1277–1281. doi:10.1002/bjs.5076[doi]

    Article  PubMed  CAS  Google Scholar 

  58. Bauer H, Fellmann E, Hermanek P, Hübner M, Jungnickel H, Kraas E, Ogasa J, Rückert K, Rümmelein D, Siefers H-F (2004) Leistenhernie. http://www.bqs-qualitaetsreport.de/2003/ergebnisse/leistungsbereiche/leistenhernie/. Accessed 28.12.2010

  59. Ekman M, Johnell O, Lidgren L (2005) The economic cost of low back pain in Sweden in 2001. Acta Orthop 76(2):275–284

    Article  PubMed  Google Scholar 

  60. Hollinsky C, Göbl S (1999) Bursting strength evaluation after different types of mesh fixation in laparoscopic herniorrhaphy. Surg Endosc 13(10):958–961

    Article  PubMed  CAS  Google Scholar 

  61. Van’t Riet M, van Steenwijk De Vos PJ, Kleinrensink GJ, Steyerberg EW, Bonjer HJ (2002) Tensile strength of mesh fixation methods in laparoscopic incisional hernia repair. Surg Endosc 16(12):1713–1716. doi:10.1007/s00464-001-9202-7

    Article  PubMed  Google Scholar 

  62. Kumar A, Doran J, Batt ME, Nguyen-van-Tam JS, Beckingham IJ (2002) Results of inguinal canal repair in athletes with sports hernia. J R Coll Surg Edinb 47(3):561–565

    PubMed  CAS  Google Scholar 

  63. Callesen T, Bech K, Nielsen R, Andersen J, Hesselfeldt P, Roikjaer O, Kehlet H (1998) Pain after groin hernia repair. Br J Surg 85(10):1412–1414. doi:10.1046/j.1365-2168.1998.00864.x[doi]

    Article  PubMed  CAS  Google Scholar 

  64. Gillion JF, Fagniez PL (1999) Chronic pain and cutaneous sensory changes after inguinal hernia repair: comparison between open and laparoscopic techniques. Hernia 3:75–80

    Article  Google Scholar 

  65. Callesen T (2003) Inguinal hernia repair: anaesthesia, pain and convalescence. Dan Med Bull 50(3):203–218

    PubMed  Google Scholar 

Download references

Acknowledgments

The results were in part presented in the doctoral thesis of Mireille Untied (nee Lucht) at the University of Frankfurt in 2007 [20].

Conflicts of interest

None.

Author information

Authors and Affiliations

  1. MedCommTools (Medical-Scientific Consultancy), Hildesheimer Str. 13, 30169, Hannover, Germany

    Hartmut Buhck

  2. Praxis am Hogenkamp, Hogenkamp 16, D-25336, Elmshorn, Germany

    Mireille Untied

  3. Klinik für Allgemein- und Viszeralchirurgie, Johann Wolfgang Goethe Universität Frankfurt am Main, Theodor-Stern-Kai 7, D-60590, Frankfurt, Germany

    Wolf O. Bechstein

Authors
  1. Hartmut Buhck
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mireille Untied
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Wolf O. Bechstein
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hartmut Buhck.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Buhck, H., Untied, M. & Bechstein, W.O. Evidence-based assessment of the period of physical inactivity required after inguinal herniotomy. Langenbecks Arch Surg 397, 1209–1214 (2012). https://doi.org/10.1007/s00423-012-1008-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00423-012-1008-7

Keywords

Search

Navigation