The best repair of a recurrent inguinal hernia after primary laparoendoscopic repair is debatable. The aim was to assess chronic pain after two laparoendoscopic repairs in the same groin compared with Lichtenstein reoperation preceded by a laparoendoscopic repair.
This cohort study included adult patients who had received two laparoendoscopic repairs (Lap–Lap) or a laparoendoscopic repair followed by the Lichtenstein repair (Lap–Lich). Eligible patients were identified in the Danish and the Swedish hernia databases. Lap–Lap was matched 1:3 with Lap–Lich, and patients were sent validated questionnaires. The primary outcome was the proportion with chronic pain-related functional impairment, compared between the two groups. Secondary outcomes included chronic pain during various activities.
In total, 74% (546 patients) responded to the questionnaires with a median follow-up since the second repair of 4.9 years (0.9–21.9 years). Regarding the primary outcome, 21% in Lap–Lap and Lap–Lich had chronic pain-related functional impairment of daily activities (p = 0.94). More patients in Lap–Lap compared with Lap–Lich reported pain ≥ 20 mm measured by the visual analog scale, 11% versus 5%, p = 0.04. However, there was no difference in the median VAS score or in the vast majority of the remaining secondary outcomes.
There was no overall difference in chronic pain between patients who had received Lap–Lap compared with Lap–Lich. Choice of operative strategy for the second repair should, therefore, not be based on risk of chronic pain.
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Jacob Rosenberg reports personal fees from Bard and Merck, outside the submitted work. Stina Öberg, Kristoffer Andresen, Hanna Nilsson, Eva Angenete reports no potential conflicts of interest and financial ties to disclose.
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Öberg, S., Andresen, K., Nilsson, H. et al. Chronic pain after two laparoendoscopic inguinal hernia repairs compared with laparoendoscopic repair followed by the Lichtenstein repair: an international questionnaire study. Surg Endosc 34, 946–953 (2020). https://doi.org/10.1007/s00464-019-06853-4
- Chronic pain
- Inguinal hernia recurrence
- Laparoendoscopic repair
- Lichtenstein repair