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Decreasing prevalence of chronic pain after laparoscopic groin hernia repair: a nationwide cross-sectional questionnaire study

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Abstract

Purpose

Up to 6–7% of patients who have undergone laparoscopic groin hernia repair suffer from chronic pain, depending on various factors; however, the long-term course is unclear. The purpose of this study was to assess the prevalence of chronic pain 1–5 years after laparoscopic groin hernia repair.

Methods

The subjects of this nationwide cross-sectional questionnaire study were adults who underwent laparoscopic mesh repair of an inguinal or a femoral hernia. The patients were identified from the Danish Hernia Database, which has a follow-up rate of almost 100%. The prevalence of chronic pain was assessed 1–5 years postoperatively by the validated inguinal pain questionnaire (IPQ).

Results

A total of 1383 groins were included in this study, based on a 66% response rate to the questionnaire. The prevalence of pain decreased, especially 3.5 years postoperatively. There were no statistically significant differences when each postoperative year was compared with the second postoperative year. However, the prevalence of chronic pain 3.5–5 years postoperatively was significantly lower (4.4%) than that 1–3.5 years postoperatively (8.1%) (p = 0.014). The prevalence of pain that could not be ignored was still 5–6% in the fifth postoperative year.

Conclusions

The prevalence of chronic pain seems to decline 1–5 years after laparoscopic groin hernia repair, with a distinct decrease 3.5 years postoperatively.

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References

  1. Fitzgibbons RJ Jr, Forse RA. Clinical practice. Groin hernias in adults. N Engl J Med. 2015;372:756–63. https://doi.org/10.1056/NEJMcp1404068.

    Article  PubMed  CAS  Google Scholar 

  2. Koch A, Edwards A, Haapaniemi S, Nordin P, Kald A. Prospective evaluation of 6895 groin hernia repairs in women. Br J Surg. 2005;92:1553–58. https://doi.org/10.1002/bjs.5156.

    Article  PubMed  CAS  Google Scholar 

  3. Primatesta P, Goldacre MJ. Inguinal hernia repair: incidence of elective and emergency surgery, readmission and mortality. Int J Epidemiol. 1996;25:835–39. https://doi.org/10.1093/ije/25.4.835.

    Article  PubMed  CAS  Google Scholar 

  4. Kingsnorth A. Treating inguinal hernias. BMJ. 2004;328:59–60. https://doi.org/10.1136/bmj.328.7431.59.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Nikkolo C, Kirsimägi Ü, Vaasna T, Murruste M, Suumann J, Seepter H, et al. Prospective study evaluating the impact of severity of chronic pain on quality of life after inguinal hernioplasty. Hernia. 2017;21:199–205. https://doi.org/10.1007/s10029-016-1569-4.

    Article  PubMed  CAS  Google Scholar 

  6. Andresen K, Burcharth J, Fonnes S, Hupfeld L, Rothman JP, Deigaard S, et al. Chronic pain after inguinal hernia repair with the ONSTEP versus the Lichtenstein technique, results of a double-blinded multicenter randomized clinical trial. Langenbecks Arch Surg. 2017;402:213–18. https://doi.org/10.1007/s00423-016-1532-y.

    Article  PubMed  Google Scholar 

  7. Alfieri S, Amid PK, Campanelli G, Izard G, Kehlet H, Wijsmuller AR, et al. International guidelines for prevention and management of post-operative chronic pain following inguinal hernia surgery. Hernia. 2011;15:239–49. https://doi.org/10.1007/s10029-011-0798-9.

    Article  PubMed  CAS  Google Scholar 

  8. Poobalan AS, Bruce J, Smith WC, King PM, Krukowski ZH, Chambers WA. A review of chronic pain after inguinal herniorrhaphy. Clin J Pain. 2003;19:48–54.

    Article  PubMed  Google Scholar 

  9. Aasvang E, Kehlet H. Chronic postoperative pain: the case of inguinal herniorrhaphy. Br J Anaesth. 2005;95:69–76. https://doi.org/10.1093/bja/aei019.

    Article  PubMed  CAS  Google Scholar 

  10. Nienhuijs S, Staal E, Strobbe L, Rosman C, Groenewoud H, Bleichrodt R. Chronic pain after mesh repair of inguinal hernia: a systematic review. Am J Surg. 2007;194:394–400.

    Article  PubMed  Google Scholar 

  11. Dahlstrand U, Sandblom G, Nordin P, Wollert S, Gunnarsson U. Chronic pain after femoral hernia repair: a cross-sectional study. Ann Surg. 2011;254:1017–21. https://doi.org/10.1097/SLA.0b013e31822ba9b6.

    Article  PubMed  Google Scholar 

  12. Andresen K, Fenger AQ, Burcharth J, Pommergaard HC, Rosenberg J. Mesh fixation methods and chronic pain after transabdominal preperitoneal (TAPP) inguinal hernia surgery: a comparison between fibrin sealant and tacks. Surg Endosc. 2017;31:4077–84. https://doi.org/10.1007/s00464-017-5454-8.

    Article  PubMed  Google Scholar 

  13. Simons MP, Aufenacker T, Bay-Nielsen M, Bouillot JL, Campanelli G, Conze J, et al. European Hernia Society guidelines on the treatment of inguinal hernia in adult patients. Hernia. 2009;13:343–403. https://doi.org/10.1007/s10029-009-0529-7.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  14. Schmedt CG, Sauerland S, Bittner R. Comparison of endoscopic procedures vs Lichtenstein and other open mesh techniques for inguinal hernia repair: a meta-analysis of randomized controlled trials. Surg Endosc. 2005;19:188–99.

    Article  PubMed  CAS  Google Scholar 

  15. von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. PLoS Med. 2007;4:e296.

    Article  Google Scholar 

  16. Friis-Andersen H, Bisgaard T. The Danish Inguinal Hernia database. Clin Epidemiol. 2016;8:521–24.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Fenger AQ, Helvind NM, Pommergaard HC, Burcharth J, Rosenberg J. Fibrin sealant for mesh fixation in laparoscopic groin hernia repair does not increase long-term recurrence. Surg Endosc. 2016;30:986–92. https://doi.org/10.1007/s00464-015-4280-0.

    Article  PubMed  Google Scholar 

  18. Pommergaard HC, Burcharth J, Andresen K, Fenger AQ, Rosenberg J. No difference in sexual dysfunction after transabdominal preperitoneal (TAPP) approach for inguinal hernia with fibrin sealant or tacks for mesh fixation. Surg Endosc. 2017;31:661–66. https://doi.org/10.1007/s00464-016-5017-4.

    Article  PubMed  CAS  Google Scholar 

  19. Franneby U, Gunnarsson U, Andersson M, Heuman R, Nordin P, Nyren O, et al. Validation of an Inguinal Pain Questionnaire for assessment of chronic pain after groin hernia repair. Br J Surg. 2008;95:488–93.

    Article  PubMed  CAS  Google Scholar 

  20. Bay-Nielsen M, Nilsson E, Nordin P, Kehlet H. Chronic pain after open mesh and sutured repair of indirect inguinal hernia in young males. Br J Surg. 2004;91:1372–76.

    Article  PubMed  CAS  Google Scholar 

  21. Aasvang EK, Bay-Nielsen M, Kehlet H. Pain and functional impairment 6 years after inguinal herniorrhaphy. Hernia. 2006;10:316–21.

    Article  PubMed  CAS  Google Scholar 

  22. Miserez M, Peeters E, Aufenacker T, Bouillot JL, Campanelli G, Conze J, et al. Update with level 1 studies of the European Hernia Society guidelines on the treatment of inguinal hernia in adult patients. Hernia. 2014;18:151–63. https://doi.org/10.1007/s10029-014-1236-6.

    Article  PubMed  CAS  Google Scholar 

  23. Koning GG, Wetterslev J, van Laarhoven CJ, Keus F. The totally extraperitoneal method versus Lichtenstein’s technique for inguinal hernia repair: a systematic review with meta-analyses and trial sequential analyses of randomized clinical trials. PLoS One. 2013;8:e52599. https://doi.org/10.1371/journal.pone.0052599.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

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

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  25. Langeveld HR, Klitsie P, Smedinga H, Eker H, Van’t Riet M, Weidema W, et al. Prognostic value of age for chronic postoperative inguinal pain. Hernia. 2015;19:549–55. https://doi.org/10.1007/s10029-014-1282-0.

    Article  PubMed  CAS  Google Scholar 

  26. Reinpold WM, Nehls J, Eggert A. Nerve management and chronic pain after open inguinal hernia repair: a prospective two phase study. Ann Surg. 2011;254:163–68. https://doi.org/10.1097/SLA.0b013e31821d4a2d.

    Article  PubMed  Google Scholar 

  27. Ferzli GS, Edwards ED, Khoury GE. Chronic pain after inguinal herniorrhaphy. J Am Coll Surg. 2007;205:333–41.

    Article  PubMed  Google Scholar 

  28. Livingston EH, Wislar JS. Minimum response rates for survey research. Arch Surg. 2012;147:110. https://doi.org/10.1001/archsurg.2011.2169.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Center for Perioperative Optimization, Department of Surgery, Herlev Hospital, University of Copenhagen, Herlev, Denmark

    Stina Öberg, Kristoffer Andresen & Jacob Rosenberg

Authors
  1. Stina Öberg
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  2. Kristoffer Andresen
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  3. Jacob Rosenberg
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Corresponding author

Correspondence to Stina Öberg.

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Conflict of interest

SÖ reports no potential conflicts of interest. KA reports personal fees from Bard outside the submitted work. JR reports personal fees from Bard and Merck, outside the submitted work.

Financial support

This study received no financial support from extramural sources. We have full control of all primary data and agree to allow the journal to review the data if requested.

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For this type of study formal consent was not required.

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Öberg, S., Andresen, K. & Rosenberg, J. Decreasing prevalence of chronic pain after laparoscopic groin hernia repair: a nationwide cross-sectional questionnaire study. Surg Today 48, 796–803 (2018). https://doi.org/10.1007/s00595-018-1664-5

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  • DOI: https://doi.org/10.1007/s00595-018-1664-5

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