World Journal of Surgery

, Volume 39, Issue 11, pp 2652–2662 | Cite as

Factors Determining Outcome After Surgery for Chronic Groin Pain Following a Lichtenstein Hernia Repair

  • Willem A. R. Zwaans
  • Tim Verhagen
  • Rudi M. H. Roumen
  • Marc R. M. Scheltinga
Original Scientific Report
First Online:

Abstract

Background

Some patients develop chronic groin pain after a Lichtenstein hernia repair. Previous studies have demonstrated beneficial effects of removal of entrapped inguinal nerves or a meshectomy in patients with chronic pain after open inguinal hernia mesh repair. Factors determining success following this remedial surgery are unknown. The aim of the study was to identify potential patient- or surgery-related factors predicting the surgical efficacy for inguinodynia following Lichtenstein repair.

Methods

Consecutive adult patients with a history of persistent pain following Lichtenstein repair who underwent remedial surgery were analysed using univariate analysis. Significant confounders (p < 0.05) were combined in a multivariate logistic regression model using a backward stepwise regression method.

Results

A total of 136 groin pain operations were available for analysis. Factors contributing to success were removal of a meshoma (OR 4.66) or a neuroma (OR 5.60) and the use of spinal anaesthesia (OR 4.38). In contrast, female gender (OR 0.30) and preoperative opioid use (OR 0.38) were significantly associated with a less favourable outcome. Using a multivariate analysis model, surgery under spinal anaesthesia (OR 4.04), preoperative use of opioids (OR 0.37), and meshoma removal (OR 5.31) greatly determined surgical outcome.

Conclusions

Pain reduction after remedial surgery for chronic groin pain after Lichtenstein repair is more successful if surgery is performed under spinal anaesthesia compared to general anaesthesia. Removal of a meshoma must be considered as success rates are optimized following these measures. Patients using opioids preoperatively have less favourable outcomes.

Keywords

Hernia Repair Spinal Anaesthesia Inguinal Hernia Repair Neuroma Groin Pain 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Abbreviations

MMC

Máxima Medical Centre

NRS

Numerical rating scale

PROM

Patient-related outcome measures

OR

Odds ratio

95 % CI

95 % confidence interval

SD

Standard deviation

ASA

American Society of Anaesthesiologists

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Notes

Acknowledgments

We would like to thank Dr. J.P. Dieleman (epidemiologist) for her contribution to the statistical analyses performed in this study.

Compliance with ethical standards

Conflict of interest

None declared.

Financial disclosure

None declared.

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Copyright information

© Société Internationale de Chirurgie 2015

Authors and Affiliations

  • Willem A. R. Zwaans
    • 1
  • Tim Verhagen
    • 1
  • Rudi M. H. Roumen
    • 1
    • 2
  • Marc R. M. Scheltinga
    • 1
    • 2
  1. 1.Department of General SurgeryMáxima Medical CentreVeldhoven/EindhovenThe Netherlands
  2. 2.SolviMáx, Centre of Excellence for Abdominal Wall and Groin PainEindhovenThe Netherlands

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