Abstract
Background
Previous studies have shown different pain characteristics in different types of laparoscopic operations, but pain pattern has not been studied in detail after laparoscopic inguinal hernia repair. To optimise preoperative patient information and postoperative analgesic treatment the present study investigated postoperative pain in terms of time course, pain intensity and individual pain components during the first 4 days after transabdominal preperitoneal hernia repair (TAPP).
Methods
The study was a single-centre prospective trial including 50 consecutive male patients with primary or recurrent inguinal and/or femoral hernia undergoing elective repair. Several pain components (visceral pain, incisional pain and shoulder pain) were studied as well as pain at the three different trocar incisions. Pain was recorded before operation and on a daily basis during the first four postoperative days using a visual analogue and a verbal rating scale. We used 1 × 12 and 2 × 5 mm trocars for TAPP.
Results
A total of 46 patients were available for analyses (age median 58 years, range 27–69 years). Visceral pain dominated significantly compared with incisional pain (P < 0.01), which again dominated over shoulder pain intensity and incidence (P < 0.01). Pain intensity did not significantly differ between different trocar incisions (5 and 12 mm) (P > 0.05). The overall pain intensity (a conglomerate of the different pain components) was most intense 3 h after TAPP and declined to preoperative levels on day 3 (P > 0.5).
Conclusion
Pain was most intense 3 h after the operation and declined to low levels within the first 3 days. Visceral pain was by far the dominating pain component compared with incisional and shoulder pain.
Similar content being viewed by others
References
Hamza Y, Gabr E, Hammadi H, Khalil R (2010) Four-arm randomized trial comparing laparoscopic and open hernia repairs. Int J Surg 8:25–28
McCormack K, Scott NW, Go PM, Ross S, Grant AM (2003) Laparoscopic techniques versus open techniques for inguinal hernia repair. Cochrane Database Syst Rev CD001785
Olmi S, Scaini A, Erba L, Guaglio M, Croce E (2007) Quantification of pain in laparoscopic transabdominal preperitoneal (TAPP) inguinal hernioplasty identifies marked differences between prosthesis fixation systems. Surgery 142:40–46
Lau H, Patil NG (2004) Acute pain after endoscopic totally extraperitoneal (TEP) inguinal hernioplasty: multivariate analysis of predictive factors. Surg Endosc 18:92–96
Pavlin DJ, Chen C, Penaloza DA, Polissar NL, Buckley FP (2002) Pain as a factor complicating recovery and discharge after ambulatory surgery. Anesth Analg 95:627–634
Kehlet H (2005) Procedure-specific postoperative pain management. Anesthesiol Clin North America 23:203–210
Kehlet H, Wilkinson RC, Fischer HB, Camu F (2007) PROSPECT: evidence-based, procedure-specific postoperative pain management. Best Pract Res Clin Anaesthesiol 21:149–159
Bisgaard T, Klarskov B, Rosenberg J, Kehlet H (2001) Characteristics and prediction of early pain after laparoscopic cholecystectomy. Pain 90:261–269
Joris J, Thiry E, Paris P, Weerts J, Lamy M (1995) Pain after laparoscopic cholecystectomy: characteristics and effect of intraperitoneal bupivacaine. Anesth Analg 81:379–384
Bisgaard T, Stockel M, Klarskov B, Kehlet H, Rosenberg J (2004) Prospective analysis of convalescence and early pain after uncomplicated laparoscopic fundoplication. Br J Surg 91:1473–1478
Eriksen JR, Poornoroozy P, Jorgensen LN, Jacobsen B, Friis-Andersen HU, Rosenberg J (2009) Pain, quality of life and recovery after laparoscopic ventral hernia repair. Hernia 13:13–21
Bittner R, Schmedt CG, Schwarz J, Kraft K, Leibl BJ (2002) Laparoscopic transperitoneal procedure for routine repair of groin hernia. Br J Surg 89:1062–1066
Oehlenschlager J, Hjorne FP, Albers M, Forsberg G, Skovdal J, Stryger V, Bisgaard T (2010) Fewer urological complications after laparoscopic inguinal hernia repair without indwelling catheter. Dan Med Bull 57:A4176
Rosenberg J, Bay-Nielsen M (2008) Current status of laparoscopic inguinal hernia repair in Denmark. Hernia 12:583–587
Kimura T, Wada H, Yoshida M, Kobayashi T, Kawabe A, Isogaki J, Ban S, Kazui T (1998) Laparoscopic inguinal hernia repair using fine-caliber instruments and polyester mesh. Surg Laparosc Endosc 8:300–303
Lau H, Lee F (2002) A prospective comparative study of needlescopic and conventional endoscopic extraperitoneal inguinal hernioplasty. Surg Endosc 16:1737–1740
Acknowledgements
The authors thank Region Zealand’s Health Research Fund (RESUS) and Department of Surgery, Køge Hospital for supporting this study.
Disclosures
Author Mette A. Tolver has received payment for lectures and travel/accommodation expenses for international meetings covered by Baxter Healthcare. Author Pernille Strandfelt has had travel/accommodation expenses for international meetings covered by Baxter Healthcare. Author Jacob Rosenberg has received payment for expert testimony from Baxter Healthcare and has had travel/accommodation expenses for international meetings covered by Johnson & Johnson. Author Thue Bisgaard has received support from Johnson & Johnson, Covidien and Baxter Healthcare and travel/accommodation expenses for international meetings covered by Baxter Healthcare.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Tolver, M.A., Strandfelt, P., Rosenberg, J. et al. Pain characteristics after laparoscopic inguinal hernia repair. Surg Endosc 25, 3859–3864 (2011). https://doi.org/10.1007/s00464-011-1810-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-011-1810-2