, Volume 10, Issue 4, pp 316–321 | Cite as

Pain and functional impairment 6 years after inguinal herniorrhaphy

  • E. K. Aasvang
  • M. Bay-Nielsen
  • H. Kehlet
Original Article


Pain impairing daily activities following inguinal herniorrhaphy is reported by about 10% of patients, when asked 1–2 years postoperatively. However, the time course and consequences of postherniorrhaphy pain is not known in detail. A nationwide follow-up questionnaire study was undertaken 6.5 years postoperatively in 335 well-described patients reporting pain 1 year after inguinal herniorrhaphy in a previous questionnaire study. Three hundred and three patients, who were alive and could be contacted, received a questionnaire 6.5 years after the herniorrhaphy. Response rate was 88%. Of 267 patients responding, 57 were analyzed separately due to subsequent inguinal herniorrhaphy or other major surgery in the observation period, leaving 210 patients (69.3%) for primary analysis. Pain from the previous hernia site was reported by 72 patients (34.3%), and 52 patients (24.8%) reported that pain affected daily activities. Less pain, compared to the 1-year follow-up, was reported by 75.8%, while 16.7% had the same intensity level and 7.5% reported increased pain severity. In the subgroup of patients operated for a recurrence during the observation period and not included in primary analysis, 22 of 44 (50%) still experienced pain at 6.5 years, and 17 (38.6%) reported that pain affected daily activities (mean observation period 4.5 years). Pain after inguinal herniorrhaphy decreased from about 11% 1 year after surgery, but still affects daily activities in about 6% after 6.5 years. Patients operated for a recurrence are at higher risk for persistent pain.


Pain Postoperative pain Chronic hernia Inguinal function Impairment 



This study was supported by a grant from The Lundbeck Foundation.


  1. 1.
    Aasvang E, Kehlet H (2005) Chronic postoperative pain-the case of inguinal herniorrhaphy. Br J Anaesth 95:69–76CrossRefPubMedGoogle Scholar
  2. 2.
    Poobalan AS, Bruce J, Smith WC, King PM, Krukowski ZH, Chambers WA (2003) A review of chronic pain after inguinal herniorrhaphy. Clin J Pain 19:48–54CrossRefPubMedGoogle Scholar
  3. 3.
    Callesen T, Bech K, Nielsen R, Andersen J, Hesselfeldt P, Roikjaer O, Kehlet H (1998) Pain after groin hernia repair. Br J Surg 85:1412–1414CrossRefPubMedGoogle Scholar
  4. 4.
    Callesen T, Bech K, Kehlet H (1999) Prospective study of chronic pain after groin hernia repair. Br J Surg 86:1528–1531CrossRefPubMedGoogle Scholar
  5. 5.
    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 88:1122–1126CrossRefPubMedGoogle Scholar
  6. 6.
    Hair A, Duffy K, McLean J, Taylor S, Smith H, Walker A, MacIntyre IM, O’Dwyer PJ (2000) Groin hernia repair in Scotland. Br J Surg 87:1722–1726CrossRefPubMedGoogle Scholar
  7. 7.
    Bay-Nielsen M, Perkins FM, Kehlet H (2001) Pain and functional impairment 1 year after inguinal herniorrhaphy: a nationwide questionnaire study. Ann Surg 233:1–7CrossRefPubMedGoogle Scholar
  8. 8.
    The 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 354:185–190CrossRefGoogle Scholar
  9. 9.
    Grant AM, Scott NW, O’Dwyer PJ (2004) Five-year follow-up of a randomized trial to assess pain and numbness after laparoscopic or open repair of groin hernia. Br J Surg 91:1570–1574CrossRefPubMedGoogle Scholar
  10. 10.
    Bay-Nielsen M, Kehlet H, Steering commitee of the Danish Hernia Database (1999) Establishment of a national Danish Hernia Database: preliminary report. Hernia 3:81–83Google Scholar
  11. 11.
    Cunningham J, Temple WJ, Mitchell P, Nixon JA, Preshaw RM, Hagen NA (1996) Cooperative hernia study. Pain in the postrepair patient. Ann Surg 224:598–602CrossRefPubMedGoogle Scholar
  12. 12.
    Neumayer L, Giobbie-Hurder A, Jonasson O, Fitzgibbons R Jr, Dunlop D, Gibbs J, Reda D, Henderson W (2004) Open mesh versus laparoscopic mesh repair of inguinal hernia. N Engl J Med 350:1819–1827CrossRefPubMedGoogle Scholar
  13. 13.
    Tschudi JF, Wagner M, Klaiber C, Brugger JJ, Frei E, Krahenbuhl L, Inderbitzi R, Boinski J, Hsu Schmitz SF, Husler J (2001) Randomized controlled trial of laparoscopic transabdominal preperitoneal hernioplasty vs shouldice repair. Surg Endosc 15:1263–1266CrossRefPubMedGoogle Scholar
  14. 14.
    Wright D, Paterson C, Scott N, Hair A, O’Dwyer PJ (2002) Five-year follow-up of patients undergoing laparoscopic or open groin hernia repair: a randomized controlled trial. Ann Surg 235:333–337CrossRefPubMedGoogle Scholar
  15. 15.
    Leibl BJ, Daubler P, Schmedt CG, Kraft K, Bittner R (2000) Long-term results of a randomized clinical trial between laparoscopic hernioplasty and shouldice repair. Br J Surg 87:780–783CrossRefPubMedGoogle Scholar
  16. 16.
    Sondenaa K, Nesvik I, Breivik K, Korner H (2001) Long-term follow-up of 1059 consecutive primary and recurrent inguinal hernias in a teaching hospital. Eur J Surg 167:125–129CrossRefPubMedGoogle Scholar
  17. 17.
    Heikkinen T, Bringman S, Ohtonen P, Kunelius P, Haukipuro K, Hulkko A (2004) Five-year outcome of laparoscopic and Lichtenstein hernioplasties. Surg Endosc 18:518–522CrossRefPubMedGoogle Scholar
  18. 18.
    Bay-Nielsen M, Nilsson E, Nordin P, Kehlet H (2004) Chronic pain after open mesh and sutured repair of indirect hernia in young males. Br J Surg 91:1372–1376CrossRefPubMedGoogle Scholar
  19. 19.
    Gillion JF, Faignez PL (1999) Chronic pain and cutaneous sensory changes after inguinal hernia repair: comparison between open and laparoscopic techniques. Hernia 3:75–80CrossRefGoogle Scholar
  20. 20.
    Courtney CA, Duffy K, Serpell MG, O’Dwyer PJ (2002) Outcome of patients with severe chronic pain following repair of groin hernia. Br J Surg 89:1310–1314CrossRefPubMedGoogle Scholar
  21. 21.
    Haapaniemi S, Nilsson E (2002) Recurrence and pain three years after groin hernia repair. Validation of postal questionnaire and selective physical examination as a method of follow-up. Eur J Surg 168:22–28CrossRefPubMedGoogle Scholar
  22. 22.
    Liem MS, van Duyn EB, van der GY, van Vroonhoven TJ (2003) Recurrences after conventional anterior and laparoscopic inguinal hernia repair: a randomized comparison. Ann Surg 237:136–141CrossRefPubMedGoogle Scholar
  23. 23.
    Aasvang E, Kehlet H (2005) Surgical management of chronic pain after inguinal hernia repair. Br J Surg 92:795–801CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  1. 1.Section of Surgical PathophysiologyThe Juliane Marie Centre, 4074CopenhagenDenmark
  2. 2.Department of Anaesthesia and Operating Theatre ServiceCentre of Head and OrthopaedicsCopenhagenDenmark
  3. 3.Danish Hernia Database Collaboration, Department of Surgical GastroenterologyH:S Hvidovre University HospitalHvidovreDenmark

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