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Is young age a risk factor for chronic postoperative inguinal pain after endoscopic totally extraperitoneal (TEP) repair?

  • W. J. BakkerEmail author
  • C. V. van Hessen
  • E. J. M. M. Verleisdonk
  • G. J. Clevers
  • P. H. P. Davids
  • N. Schouten
  • J. P. J. Burgmans
Original Article



A generally known risk factor for developing chronic postoperative inguinal pain after inguinal hernia repair is young age. However, studies discussing young age as a risk factor are mainly based on open repairs. The aim of this study was to determine if young adults (age 18–30) are also more prone to experience chronic postoperative inguinal pain after totally extraperitoneal (TEP) inguinal hernia repair, compared to older adults (age ≥ 31).


A prospective study was conducted in a high-volume TEP hernia clinic in 919 patients. Patients were assessed using the Numeric (Pain) Rating Scale, Inguinal Pain Questionnaire and Carolina Comfort Scale preoperatively, at 3 months, 1 year and 2 years after TEP mesh repair. The primary outcome was clinically relevant pain in young adults compared to older adults at 3 months follow-up. Secondary outcomes were pain 1 and 2 years postoperatively, the impact of pain on daily living, foreign body feeling and testicular pain. Furthermore, age categories were analyzed to determine potential age-dependent risk factors.


Follow-up was completed in 867 patients. No significant difference was found between young adults and older adults for clinically relevant pain at 3 months follow-up (p = 0.723). At all follow-up time points, no significant differences were found for clinically relevant pain, any pain, mean pain scores, the Inguinal Pain Questionnaire and the Carolina Comfort Scale. The subgroup analyses showed no age-dependent risk factor.


Young age is not associated with a higher risk of chronic postoperative inguinal pain after endoscopic TEP hernia repair.


Inguinal hernia TEP Chronic pain Chronic postoperative inguinal pain Risk factor Young age 


Author contributions

WB: study conception and design, data collection, analysis and interpretation of data, and drafting of manuscript. CH: study conception and design, interpretation of data, and critical revision. EV: study conception and design, and critical revision. GC: study conception and design, and critical revision. PD: study conception and design, and critical revision. NS: data collection and critical revision. JB: study conception and design, drafting of manuscript, interpretation of data, and critical revision.


A research grant has been assigned to the Diakonessenhuis/Hernia Clinic Zeist by Johnson & Johnson Medical BV to partially support all research regarding the endoscopic totally extraperitoneal hernia repair.

Compliance with ethical standards

Conflict of interest

Author WB, author CH, author EV, author GC, author PD, author NS, and author JB declare that they have no conflict of interests.

Ethical approval

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.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Ethical standards

Ethical approval was obtained by the Regional Medical Ethics Committee and the hospital’s Ethics Board.


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Copyright information

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

Authors and Affiliations

  1. 1.Department of Surgery, Hernia ClinicDiakonessenhuisUtrechtThe Netherlands
  2. 2.Department of SurgeryMáxima Medical CentreEindhovenThe Netherlands

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