Abstract
Background
Chronic pain is an important outcome variable after inguinal hernia repair that is generally not assessed by objective methods. The aim of this study was to objectively investigate chronic pain and hypoesthesia after inguinal hernia repair using three types of operation: open suture, open mesh, and laparoscopic.
Methods
A total of 96 patients were included in the study with a median follow-up of 4.7 years. Open suture repair was performed in 40 patients (group A), open mesh repair in 20 patients (group B), and laparoscopic repair in 36 patients (group C). Hypoesthesia and pain were assessed using von Frey monofilaments. Quality of life was investigated with Short Form 36.
Results
Pain occurring at least once a week was found in 7 (17.5%) patients of group A, in 5 (25%) patients of group B, and in 6 (16.6%) patients of group C. Area and intensity of hyposensibility were increased significantly after open nonmesh and mesh repair compared to those after laparoscopy (p = 0.01). Hyposensibility in patients who had laparoscopic hernia repair was significantly associated with postoperative pain (p = 0.03). Type of postoperative pain was somatic in 19 (61%), neuropathic in 9 (29%), and visceral in 3 (10%) patients without significant differences between the three groups.
Conclusions
The incidence of hypoesthesia in patients who had laparoscopic hernia repair is significantly lower than in those who had open hernia repair. Hypoesthesia after laparoscopic but not after open repair is significantly associated with postoperative pain. Von Frey monofilaments are important tools for the assessment of inguinal hypoesthesia and pain in patients who had inguinal hernia repair allowing quantitative and qualitative comparison between various surgical techniques.
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References
Grant AM (2002) Open mesh versus non-mesh repair of groin hernia: meta-analysis of randomised trials based on individual patient data [corrected]. Hernia 6(3): 130–136
Memon MA, Cooper NJ, Memon B, Memon MI, Abrams KR (2003) Meta-analysis of randomized clinical trials comparing open and laparoscopic inguinal hernia repair. Br J Surg 90(12): 1479–1492
Bay-Nielsen M, Perkins FM, Kehlet H (2001) Pain and functional impairment 1 year after inguinal herniorrhaphy: a nationwide questionnaire study. Ann Surg 233(1): 1–7
Poobalan AS, Bruce J, King PM, Chambers WA, Krukowski ZH, Smith WC (2001) Chronic pain and quality of life following open inguinal hernia repair. Br J Surg 88(8): 1122–1126
Aasvang E, Kehlet H (2005) Chronic postoperative pain: the case of inguinal herniorrhaphy. Br J Anaesth 95(1): 69–76
Callesen T, Bech K, Kehlet H (1999) Prospective study of chronic pain after groin hernia repair. Br J Surg 86(12): 1528–1531
Cunningham J, Temple WJ, Mitchell P, Nixon JA, Preshaw RM, Hagen NA (1996) Cooperative hernia study. Pain in the postrepair patient. Ann Surg 224(5): 598–602
Poobalan AS, Bruce J, Smith WC, King PM, Krukowski ZH, Chambers WA (2003) A review of chronic pain after inguinal herniorrhaphy. Clin J Pain 19(1): 48–54
McCormack K, Scott NW, Go PM, Ross S, Grant AM (2003) Laparoscopic techniques versus open techniques for inguinal hernia repair. Cochrane Database Syst Rev (1):CD001785
Mikkelsen T, Werner MU, Lassen B, Kehlet H (2004) Pain and sensory dysfunction 6 to 12 months after inguinal herniotomy. Anesth Analg 99(1): 146–151
International Association for the Study of Pain (1986) Classification of chronic pain. Descriptions of chronic pain syndromes and definitions of pain terms. Prepared by the International Association for the Study of Pain Subcommittee on Taxonomy. Pain Suppl 3: S1–S226
Striffeler H, Zufferey S, Schweizer W (1993) Quality control after introduction of a new hernia technique. Barwell transversal fascia-plasty. Helv Chir Acta 59(5–6): 771–774
Amid PK, Shulman AG, Lichtenstein IL (1996) Open “tension-free” repair of inguinal hernias: the Lichtenstein technique. Eur J Surg 162(6): 447–453
Gerber S, Hammerli PA, Glattli A (2000) Laparoscopic transabdominal preperitoneal hernioplasty. Evaluation of complications due to transabdominal approach. Chirurg 71(7): 824–828
Bay-Nielsen M, Nilsson E, Nordin P, Kehlet H (2004) Chronic pain after open mesh and sutured repair of indirect inguinal hernia in young males. Br J Surg 91(10): 1372–1376
Nordin P, Bartelmess P, Jansson C, Svensson C, Edlund G (2002) Randomized trial of Lichtenstein versus Shouldice hernia repair in general surgical practice. Br J Surg 89(1): 45–49
Vrijland WW, van den Tol MP, Luijendijk RW, Hop WC, Busschbach JJ, de Lange DC, van Geldere D, Rottier AB, Vegt PA, JN IJ, Jeekel J (2002) Randomized clinical trial of non-mesh versus mesh repair of primary inguinal hernia. Br J Surg 89(3): 293–297
MRC Laparoscopic Groin Hernia Trial Group (1999) Laparoscopic versus open repair of groin hernia: a randomised comparison. The MRC Laparoscopic Groin Hernia Trial Group. Lancet 354(9174): 185–190
EU Hernia Trialists Collaboration (2002) Repair of groin hernia with synthetic mesh: meta-analysis of randomized controlled trials. Ann Surg 235(3): 322–332
Kumar S, Wilson RG, Nixon SJ, Macintyre IM (2002) Chronic pain after laparoscopic and open mesh repair of groin hernia. Br J Surg 89(11): 1476–1479
Canonico S, Santoriello A, Campitiello F, Fattopace A, Corte AD, Sordelli I, Benevento R (2005) Mesh fixation with human fibrin glue (Tissucol) in open tension-free inguinal hernia repair: a preliminary report. Hernia 9: 330–333
Helbling C, Schlumpf R (2003) Sutureless Lichtenstein: first results of a prospective randomised clinical trial. Hernia 7(2): 80–84
Hidalgo M, Castillo MJ, Eymar JL, Hidalgo A (2005) Lichtenstein inguinal hernioplasty: sutures versus glue. Hernia 9: 242–244
Topart P, Vandenbroucke F, Lozac’h P (2005) Tisseel versus tack staples as mesh fixation in totally extraperitoneal laparoscopic repair of groin hernias: a retrospective analysis. Surg Endosc 19(5): 724–727
Acknowledgments
The authors thank Ramun Berger for the generation of a computer model to calculate and display measured data by von Frey monofilaments.
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This work was presented at the 10th World Congress of Endoscopic Surgery, Berlin, Germany, 13–16 September 2006
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Beldi, G., Haupt, N., Ipaktchi, R. et al. Postoperative hypoesthesia and pain: qualitative assessment after open and laparoscopic inguinal hernia repair. Surg Endosc 22, 129–133 (2008). https://doi.org/10.1007/s00464-007-9388-4
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DOI: https://doi.org/10.1007/s00464-007-9388-4