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Sustainability of the relationship between preoperative symptoms and postoperative improvement in quality of life after inguinal hernia repair

  • J. MagnussonEmail author
  • U. O. Gustafsson
  • J. Nygren
  • A. Thorell
Original Article



Chronic pain and discomfort are common before and after inguinal hernia repair (IHR) and pain is clearly linked to reduced quality of life (QoL). The long-term effect of IHR on QoL in relation to preoperative symptoms is incompletely described.


309 men (18–75 years) undergoing IHR under local anesthesia and day care surgery were included. Pre- and postoperative symptoms, pain and QoL (SF-36) were measured before and up to 3 years after surgery.


Before surgery, 197 patients (64%) reported pain (VAS 0.9–5.4) from their inguinal hernia. 102 patients (33%) had other inguinal symptoms, and 26% were asymptomatic. Patients with preoperative groin pain (P) scored their physical QoL (PCS) lower compared with controls (C) (median (IQR) 43.5 (34.7–50.3) vs. 53.9 (47.8–56.9, p < 0.001)), whereas patients with no pain (N) did not (53.0 (47.9–55.9), p = 0.57). Mental QoL was not affected before or after surgery. At 1, 2 and 3 years after surgery, 14, 12 and 7% of patients, respectively, reported groin pain. In P, PCS increased from 43.5 before surgery to 55.3 (p < 0.001) at 36 months, but was unchanged in N (53.0 vs 55.9, p = ns).


The incidence of inguinal pain decreases over time after inguinal hernia repair. Both preoperative reduction and long-term improvement in physical QoL are strongly associated with the presence of preoperative groin pain. This supports, from a QoL perspective, that patients with preoperative pain are those who benefit the most from IHR, also from a long-term perspective.


Inguinal hernia repair Quality of life Postoperative pain SF-36 



Quality of life


Inguinal hernia repair


Local anesthesia


Short Form 36


Visual analogue scale


Physical Component Score


Mental Component Score


Body mass index


Group of patients without preoperative inguinal pain


Group of patients with preoperative inguinal pain


Effect size



We would like to thank Karin Sadarangani-Lindström, Anette Bratt, Monica Johansson and Charlotte Norberg-Jönsson for their assistance in patient recruitment, excellent nursing and technical support.


This work was supported by funds from Karolinska Institutet, Stockholm and Stockholm County Council (ALF) and by grants from The Erling-Persson Family Foundation, Sweden.

Compliance with ethical standards

Conflict of interest

The authors declare no conflict of interest.

Human and animal rights

All applicable international, national and/or institutional guidelines for the care and use of animals were followed.

Ethical approval

The study (NCT01699971) was approved by the regional ethics committee.

Informed consent

Informed consent was obtained from all individual participants included in the study. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.


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Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2019

Authors and Affiliations

  • J. Magnusson
    • 1
    • 2
    Email author
  • U. O. Gustafsson
    • 1
    • 3
  • J. Nygren
    • 1
    • 2
  • A. Thorell
    • 1
    • 2
  1. 1.Karolinska Institutet, Department of Clinical SciencesDanderyds HospitalStockholmSweden
  2. 2.Department of SurgeryErsta HospitalStockholmSweden
  3. 3.Department of SurgeryDanderyds HospitalStockholmSweden

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