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Chronic groin pain, discomfort and physical disability after recurrent groin hernia repair: impact of anterior and posterior mesh repair

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Abstract

Chronic pain and physical disability are well-known problems after primary groin hernia surgery, but the outcome after recurrent hernia surgery is much less known.

Purpose

To study the impact of anterior mesh repair (AMR) and posterior mesh repair (PMR) on chronic pain and disability after first recurrent groin hernia surgery in a population-based cohort derived from the Swedish Hernia Register.

Methods

Consecutive unilateral, first and second recurrent hernia repairs, registered between 1998 and 2007, were included. Follow-up was performed in 2009 based on the Inguinal Pain Questionnaire (IPQ) and selective clinical examination, comparing prevalence of pain between AMR, endoscopic (E-PMR) and open posterior mesh repairs (O-PMR) after first recurrent repair. Chronic pain after a second recurrent repair was analysed.

Results

Altogether 671 first recurrent repairs were analysed: 329 AMRs, 161 E-PMRs and 181 O-PMRs. IPQ response rate was 70.6 %. If the index repair was anterior, the E-PMR was associated with a lower risk of chronic pain and disability compared to AMR [OR 0.54 (CI 0.30–0.97), p = 0.039]. The risk of chronic pain increased after a second recurrent repair. A surgeon’s annual volume >5 O-PMRs was related to a lower risk compared to ≤5 [OR 0.42 (CI 0.19–0.94), p = 0.034].

Conclusion

Endoscopic repair for first recurrent groin hernia surgery, after an index anterior repair, was associated with less chronic pain, discomfort and disability compared to anterior approach. Chronic pain increased after a second recurrent repair. A high surgeon’s volume reduced the risk of chronic pain after open posterior mesh repair.

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Acknowledgments

The work was supported by a grant from the Olle Engqvist Research Foundation.

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Authors and Affiliations

  1. Department of Surgery, Skåne University Hospital, 221 85, Lund, Malmö, Sweden

    D. Sevonius & A. Montgomery

  2. Department of Surgery, Helsingborg Hospital, Helsingborg, Sweden

    S. Smedberg

  3. Karolinska Institute, CLINTEC, Stockholm, Sweden

    G. Sandblom

Authors
  1. D. Sevonius
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  2. A. Montgomery
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  3. S. Smedberg
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  4. G. Sandblom
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Corresponding author

Correspondence to D. Sevonius.

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Conflict of interest

D. Sevonius declares grants from the Olle Engqvist Research Foundation and Board member of the Swedish Hernia Register (no honorarium). A. Montgomery declares grants from University Hospital Research funds and Member of the International Advisory Board of Ethicon, in the group dealing with hernia problems, since several years (no honorarium), Member of the Council of British Journal of Surgery since several years (no honorarium), newly elected Associate Editor of Hernia (no honorarium), Board Member of European Hernia Society (no honorarium), President of the Swedish Surgical Society (no honorarium), Board Member of the Swedish Hernia Register (no honorarium). S. Smedberg declares grant from Board Member of the Swedish Hernia Register (no honorarium). G. Sandblom declares grant from Board Member of the Swedish Hernia Register (no honorarium), Scientific Advisor to Novus Scientific (no honorarium).

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Sevonius, D., Montgomery, A., Smedberg, S. et al. Chronic groin pain, discomfort and physical disability after recurrent groin hernia repair: impact of anterior and posterior mesh repair. Hernia 20, 43–53 (2016). https://doi.org/10.1007/s10029-015-1439-5

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