Abstract
Background
The incidence of chronic pain after Kugel herniorrhaphy is not well documented, since it was not used as a primary outcome measure in studies reporting on the Kugel technique. The aim of the present study was to report on the incidence and severity of chronic pain 1 year after Kugel herniorrhaphy and to identify the risk factors associated with the development of chronic pain.
Methods
The study population comprised all patients in our teaching hospital who underwent a Kugel inguinal hernia repair between January 2002 and June 2005. Postoperative complications, analgesia consumption and postoperative functional impairment were recorded during an outpatient clinic after 4–6 weeks. Chronic pain and cutaneous sensory changes were followed-up by means of a telephone questionnaire 1 year after surgery.
Results
After 1 year, 57 (15.1%) of 377 patients complained of mild to moderate pain. The incidence of mild and moderate chronic pain was 14.3 and 0.8%, respectively. None of the patients had severe chronic pain. Only one patient reported numbness in the groin area. Age and immediate postoperative pain were significant risk factors associated with chronic pain after Kugel inguinal herniorrhaphy. Although the difference was not significant, female patients seemed to be more prone to develop chronic pain.
Conclusions
The Kugel inguinal hernia repair is associated with a low rate of postoperative chronic pain. The minimally invasive preperitoneal approach of the Kugel technique probably causes less nerve damage and subsequent neuropathic pain. Chronic pain seems to be more common in young female patients with immediate postoperative pain.
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References
Kugel D (1999) Minimally invasive, nonlaparoscopic, preperitoneal, and sutureless, inguinal herniorrhaphy. Am J Surg 178:298–302
Nyhus LM, Codon RE, Harkins HN (1960) Clinical experiences with preperitoneal hernia repair for all types of hernia in the groin. Am J Surg 100:234–244
Stoppa RE, Warlaumont CR, Verhaeghe PJ, Romero ER, M’Balla-N’Di CJ (1986) Prosthetic repair in the treatment of groin hernias. Int Surg 71:154–158
Soper NJ, Brunt LM, Kerbl K (1994) Laparoscopic general surgery. N Engl J Med 330:409–419
Crawford DL, Philips EH (2002) Laparoscopic totally extraperitoneal herniorrhaphy. In: Fitzgibbons RJ, Greenburg AG (eds) Nyhus and Condon’s hernia. 5th edn. Lippincot Williams and Wilkins, Philadelphia, pp 239–253
Misawa T, Sakurai M, Kanai H, Masato M, Yoji Y, Katsuhiko Y (2005) Kugel herniorrhaphy: clinical results of 124 consecutive operations. Surg Today 35:639–644
Ceriani V, Faleschini E, Bignami P, Lodi T, Roncaglia O, Osio C, Sarli D (2005) Kugel hernia repair: open “mini-invasive” technique. Personal experience on 620 patients. Hernia 9:344–347
Reddy KM, Humphreys W, Chew A, Toouli J (2005) Inguinal hernia repair with the Kugel patch. ANZ J Surg 75:43–47
Nienhuijs S, Staal E, Keemers-Gels M, Rosman C, Strobbe L (2007) Pain after open preperitoneal repair versus Lichtenstein repair: a randomized trial. World J Surg. DOI 10.1007/s00268-007-9090-7
The EU Hernia Trialists Collaboration (2002) Repair of groin hernia with synthetic mesh. Meta-analysis of randomized controlled trials. Ann Surg 235:322–332
Nienhuijs SW, Boelens OBA, Strobbe LJA (2005) Pain after anterior mesh hernia repair. J Am Coll Surg 200:885–889
Bay-Nielsen M, Nilsson E, Nordin P, Kehlet H (2004) Chronic pain after open mesh and sutured repair for indirect inguinal hernia in young males. Br J Surg 91:1372–1376
Poobalan AS, Bruce J, Smith WCS, Cairns W, King PM, Krukowski ZH, Chambers WA (2003) A review of chronic pain after inguinal herniorrhaphy. Clin J Pain 19:48–54
Bay-Nielsen M, Perkins FM, Kehlet H (2001) Pain and functional impairment 1 year after inguinal herniorrhaphy: a nationwide questionnaire study. Ann Surg 233:1–7
Poobalan AS, Bruce J, King PM, Chambers WA, Krukowski ZH, Smith WCS (2001) Chronic pain and quality of life following open inguinal hernia repair. Br J Surg 88:1122–1126
Callesen T, Beck K, Kehlet H (1999) Prospective study of chronic pain after groin hernia repair. Br J Surg 86:1528–1531
Gillion JF, Fagniez PL (1999) Chronic pain and cutaneous sensory changes after inguinal hernia repair: comparison between open and laparoscopic techniques. Hernia 3:75–80
Cunningham J, Temple WJ, Mitchell P, Nixon JA, James A, Preshow RM, Hagen NA (1996) Cooperative hernia study: pain in the postrepair patient. Ann Surg 224:598–602
Schmedt CG, Sauerland S, Bittner R (2005) Comparison of endoscopic procedures vs Lichtenstein and other open mesh techniques for inguinal hernia repair. A meta-analysis of randomized controlled trials. Surg Endosc 19:188–199
Bower S, Moore BB, Weiss SM (1996) Neuralgia after inguinal hernia repair. Am Surg 62:664–667
Schumpelick V, Treutner KH, Arit G (1994) Inguinal hernia repair in adults. Lancet 344:375–379
Lichtenstein IL, Schulman AG, Amid PK, Montllor MM (1988) Cause and prevention of postherniorrhaphy neuralgia: a proposed protocol for treatment. Am J Surg 155:786–790
Wantz GE (1993) Testicular artrophy and chronic residual neuralgia as risks of inguinal hernioplasty. Surg Clin North Am 73:571–581
Choi PD, Nath R, Mackinnon SE (1996) Iatrogenic injury to the ilioinguinal and iliohypogastric nerves in the groin: a case report, diagnosis, and management. Ann Plast Surg 37:60–65
Franneby U, Sandblom G, Nordin P, Nyren O, Gunnarsson U (2006) Risk factors of long term pain after hernia surgery. Ann Surg 244:212–219
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 91:1570–1574
Douek M, Smith G, Oshowo A, Stoker DL, Wellwood JM (2003) Prospective randomised controlled trial of laparoscopic versus open inguinal hernia mesh repair: five year follow up. BMJ 326:1012–1013
Aasvang E, Kehlet H (2005) Chronic postoperative pain: the case of inguinal herniorrhaphy. Br J Anaesth 95:69–76
National Institute for Clinical Excellence (2004) Guidance on the use of laparoscopic surgery for inguinal hernia repair. NICE, London
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 89:1310–1314
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Hompes, R., Vansteenkiste, F., Pottel, H. et al. Chronic pain after Kugel inguinal hernia repair. Hernia 12, 127–132 (2008). https://doi.org/10.1007/s10029-007-0295-3
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DOI: https://doi.org/10.1007/s10029-007-0295-3