Risk factors for long-term pain after hernia surgery

Psychosocial predictors and correlates for chronic post-surgical pain (CPSP) - a systematic review

Chronic post-surgical pain (CPSP) is a serious problem. Incidence as high as 50% has been reported, depending on type of surgery undergone. Because the etiology of chronic pain is grounded in the bio-psychosocial model, physical, psychological, and social factors are implicated in the development of CPSP. Biomedical factors such as pre-operative pain, severe acute post-operative pain, modes of anesthesia, and surgical approaches have been extensively examined, therefore this systematic review focuses on psychosocial elements. A systematic search was performed using the PubMed, PsychINFO, Embase, and Cochrane Databases. Fifty relevant publications were selected from this search, in which psychosocial predictors for and correlates to CPSP were identified. The level of evidence was assessed for each study, and corresponding score points were awarded for ease of comparison. The grade of association with CPSP for each predictor/correlate was then determined. Depression, psychological vulnerability, stress, and late return to work showed likely correlation with CPSP (grade of association=1). Other factors were determined to have either unlikely (grade of association=3) or inconclusive (grade of association=2) correlations. In addition, results were examined in light of the type of surgery undergone. This review is intended as a first step to develop an instrument for identifying patients at high risk for CPSP, to optimize clinical pain management.

Self-reported adverse events after groin hernia repair, a study based on a national register

OBJECTIVES

In most clinics, follow-up after inguinal hernia surgery is not a routine procedure and complications may pass unnoticed, thus impairing quality assessment. The aim of this study was to investigate the frequency, spectrum, and risk factors of short-term adverse events after groin hernia repair.

METHODS

All patients aged 15 years or older with a primary unilateral inguinal or femoral hernia repair recorded in the Swedish Hernia Register (SHR) between November 1 and December 31, 2002 were sent a questionnaire asking about complications within the first 30 postoperative days.

RESULTS

Of the 1643 recorded patients, 1448 (88.1%) responded: 1341 (92.6%) were men and 107 (7.4%) women, mean age 59 years. There were 195 (11.9%) nonresponders. Postoperative complications reported in the questionnaire were hematoma in 203 (14.0%) patients, severe pain in 168 (11.6%), testicular pain in 120 (8.3%), and infection in 105 (7.3%). Adverse events were reported in the questionnaire by 391 (23.8%) patients, whereas only 85 (5.2%) were affected according to the SHR. Risk factors for postoperative complications were age below the median (59 years) among the studied hernia patients (OR 1.36; 95% CI 1.06-1.74) and laparoscopic repair (OR 2.66; 95% CI 1.17-6.05).

CONCLUSION

Questionnaires provide valuable additional information concerning postoperative complications. We recommend that they become an integrated part of routine postoperative assessment.

Combined Open and Laparoscopic Approach to Chronic Pain after Inguinal Hernia Repair

Chronic groin pain is the most frequent long-term complication after inguinal hernia repair affecting up to 34 per cent of patients. Traditional surgical management includes groin exploration, mesh removal, and neurectomy. We evaluate outcomes of a combined laparoscopic and open approach to chronic pain after inguinal herniorrhaphy. All patients undergoing surgical exploration for chronic pain after inguinal herniorrhaphy were analyzed. In most, the operation consisted of mesh removal (open or laparoscopic), neurectomy, and placement of mesh in the opposite location of the first mesh (laparoscopic if the first was open and vice-versa). Main outcome measures included pain status, numbness, and hernia recurrence. Twenty-one patients (16 male and 5 female) with a mean age of 41 years (22–51 years) underwent surgical treatment for unilateral (n = 18) or bilateral (n = 3) groin pain. Percutaneous nerve block was unsuccessful in all patients. Four had previous surgery for pain. There were no complications. With a minimum of 6 weeks follow-up, 20 of 21 patients reported significant improvement or resolution of symptoms. A combined laparoscopic and open approach for postherniorrhaphy groin pain results in excellent patient satisfaction with minimal morbidity. It may be the preferred technique for the definitive management of chronic neuralgia after hernia repair.

The assessment of quality of life in a trial on lightweight mesh fixation with fibrin sealant in transabdominal preperitoneal hernia repair

BACKGROUND

Chronic pain is a major concern in open and laparoscopic hernia repair. Study groups have adopted a variety of tools to assess postoperative (postOP) pain and quality of life (QoL). Unfortunately, modifications of existing tests and self-designed questionnaires are common, yielding unvalidated results and making comparison of data difficult. The aim of this study was to assess the QoL in transabdominal preperitoneal mesh repair (TAPP) with fibrin sealant (FS) for lightweight mesh fixation, applying the standardised Short Form 36 (SF36) questionnaire in its unmodified design. The SF36 has already been validated and implemented in a large number of studies. In this trial the physical-health-component summary measure (PHM), summarising the physical health-related scales, served as the primary outcome parameter.

MATERIALS AND METHODS

After informed written consent was obtained, TAPP with fibrin mesh sealing was performed in 11 non-selected consecutive patients by a single surgeon. A direct control group (e.g. TAPP with staples) was not enrolled, because a favourable change in the QoL in patients subjected to the mesh sealing approach was the tested hypothesis and not the comparison of techniques. The macroporous mesh (TI-Mesh, GfE, Germany) was fixed with 1 ml of FS (FS, Tisseel, Tissucol, Baxter Biosciences, Austria), and the QoL and pain were assessed preoperatively and 1 year postOP using the SF36 survey and the visual analogue score (VAS).

RESULTS

After 12 months, recurrences or complications were observed. The analysis of the unmodifed SF36 revealed a highly significant improvement in the PHM, based on significant changes of all physical-health-related scales. The scale 'social functioning' (SOCIAL), which belongs to the mental-health-related scale, had also significantly improved. The VAS was significantly reduced after 1 year.

CONCLUSIONS

Despite a small number of patients (n = 11), a strikingly significant improvement in physical health and reduction of pain was detected with the unmodified SF36 and the VAS 1 year after TAPP repair with fibrin-sealed lightweight meshes. We suggest the use of the unmodified SF36 for QoL in hernia repair in order to assess all aspects of recovery (physical and mental) and to facilitate comparison of data.

Postherniorrhaphy groin pain and how to avoid it

Groin pain following inguinal hernia repair remains a challenge to most general surgeons. Prevention of groin pain may be the most effective solution to this management problem and necessitates careful anatomic dissection and precise knowledge of surgical anatomy of the groin as well as potential pitfalls of surgical intervention. When complications arise, a period of watchful waiting is warranted, but surgical intervention with triple neurectomy offers the most definitive resolution of symptoms. This article aims to provide a thorough review of pertinent anatomic landmarks for the proper identification of the nerves that, if injured, result in chronic groin pain and to provide a treatment algorithm for patients suffering with this morbidity.

An overview of the features influencing pain after inguinal hernia repair

Pain is a prominent issue in inguinal hernia repair research as its persisting appearance is a severe complication. The interest is also urged by the combination of a high number of repairs with an estimated risk for chronic postoperative pain of 11%. Almost every healthcare provider could encounter this complication. Pain is a complex study subject, mostly defined as an unpleasant sensory and emotional experience associated with actual or potential tissue damage. Various explanatory factors for pain following hernia repair have been reported. Most investigators, however, discuss only a few aspects. In the present review, these factors are collected to provide a more holistic synopsis of pain following hernia repair. It may be a resource for understanding this and other postsurgical pain.

Pain and disability 1 year after knee arthroscopic procedures

BACKGROUND

Persistent chronic pain after surgery is a major health care problem. Its prevalence after knee arthroscopy is unknown. We conducted a follow-up of knee arthroscopy patients. The aims were to estimate the prevalence of pain at rest and during activity 1 year after knee arthroscopy.

METHODS

One hundred patients with moderate or severe acute pain after knee arthroscopy were included in one of two randomized-controlled pain trials. A questionnaire was mailed to all the patients 1 year after inclusion.

RESULTS

The prevalence of pain at rest 1 year after surgery [numeric rating scale (NRS) 0-10 grade >/=1] was 30% (95% CI 17-47) in women and 29% (95% CI 17-46) in men. Four of 33 female (10%) and three of 34 male patients (9%) experienced pain intensities at rest of NRS>4, and the number of patients who had experienced NRS>4 during activities were 7 (21%) and 4 (11%), respectively. Age above 50 years was positively correlated to persistent pain. The number of patients who reported a reduced activity of daily living (ADL) due to pain (NRS>4) was 14 of 33 (42%, 95% CI 28-56%) in female and five of 34 (15%, 95% CI 5-25%) in male patients (P=0.03). Age above 50 years was positively correlated to impaired ADL function due to knee pain.

CONCLUSIONS

Persistent pain after knee arthroscopy may be a significant health care problem. Age and female gender are independent risk factors for pain and disability 1 year after surgery.

Comparison of generic versus specific quality-of-life scales for mesh hernia repairs

BACKGROUND

With the use of mesh shown to considerably reduce recurrence rates for hernia repair and the subsequent improvement in clinical outcomes, focus has now been placed on quality-of-life outcomes in patients undergoing these repairs, specifically, as they relate to the mesh prosthesis. Traditionally, quality of life after hernia surgery, like many other medical conditions, has been tested using the generic SF-36 survey. The SF-36 quality-of-life survey, although well studied and validated, may not be ideal for patients undergoing hernia repairs. We propose a new quality-of-life survey, the Carolinas Comfort Scale (CCS), pertaining specifically to patients undergoing hernia repair with mesh; our goal was to test the validity and reliability of this survey.

STUDY DESIGN

The CCS questionnaire was mailed to 1,048 patients to assess its acceptability, responsiveness, and psychometric properties. The survey sample included patients who were at least 6 months out after hernia repair with mesh. Patients were asked to fill out the CCS and the generic SF-36 questionnaires, four questions comparing the two surveys, and their overall satisfaction relating to their hernia repair and mesh.

RESULTS

The reliability of the CCS was confirmed by Cronbach's alpha coefficient (0.97). Test-retest validity was supported by the correlation found between two different administrations of the CCS; both Spearman's correlation coefficient and the kappa coefficient were important for each question of the CCS. Assessment of its discriminant validity showed that both the mean and median scores for satisfied patients were considerably lower than those for dissatisfied patients. Concurrent validity was demonstrated by the marked correlations found between the CCS and SF-36 questionnaire scales. When comparing the two surveys, 72% of patients preferred the CCS questionnaire, 80% believed it was easier to understand, 66% thought it was more reflective of their condition, and 69% said they would rather fill it out over the SF-36.

CONCLUSIONS

The CCS better assesses quality of life and satisfaction of patients who have undergone surgical hernia repair than the generic SF-36.

Does delaying repair of an asymptomatic hernia have a penalty?

BACKGROUND

The incidence of hernia accident for inguinal hernias in men who are minimally symptomatic is sufficiently low that watchful waiting is an acceptable alternative to routine repair. Our aim was to determine whether a delay in hernia surgery affects short- and long-term outcomes.

METHODS

Patients from a multicenter randomized clinical trial of immediate tension-free repair versus watchful waiting for minimally symptomatic inguinal hernias were studied. Patients (n = 353) underwent tension-free repair and were classified as immediate repair (< or = 6 months, N = 288) or delayed repair (> 6 months, N = 65).

RESULTS

Patients were similar at baseline with respect to age, American Society of Anesthesiologists classification, pre-existing conditions, hernia type, and hernia characteristics. Patients undergoing immediate and delayed repair had comparable surgical time, surgical complications, recurrence rates, and satisfaction with outcome. Multivariate analyses found no relation between duration until hernia repair and operative time, incidence of complications, long-term pain, or functional status.

CONCLUSIONS

Delaying hernia repair in patients who are minimally symptomatic does not have an adverse effect on subsequent operation and on other outcomes.

Validation of an Inguinal Pain Questionnaire for assessment of chronic pain after groin hernia repair

Background

Long-term pain is an important outcome after inguinal hernia repair. The aim of this study was to test the validity and reliability of a specific Inguinal Pain Questionnaire (IPQ).

Methods

The study recruited patients aged between 15 and 85 years who had undergone primary inguinal or femoral hernia repair. To test the validity of the questionnaire, 100 patients received the IPQ and the Brief Pain Inventory (BPI) 1 and 4 weeks after surgery (group 1). To test reliability and internal consistency, 100 patients received the IPQ on two occasions 1 month apart, 3 years after surgery (group 2). Non-surgery-related pain was analysed in group 3 (2853 patients).

Results

A significant decrease in IPQ-rated pain intensity was observed in the first 4 weeks after surgery (P &lt; 0·001). Significant correlations with corresponding BPI pain intensity items corroborated the criterion validity (P &lt; 0·050). Logical incoherence did not exceed 5·5 per cent for any item. Values for κ in the test–retest in group 2 were higher than 0·5 for all but three items. Cronbach's α was 0·83 for questions on pain intensity and 0·74 for interference with daily activities.

Conclusion

This study found good validity and reliability for the IPQ, making it a useful instrument for assessing pain following groin hernia repair.

Chronic pain after Kugel inguinal hernia repair

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.

Evaluating postherniorrhaphy groin pain: Visual Analogue or Verbal Rating Scale?

INTRODUCTION

Several tools for pain measurement including a Visual Analogue Scale (VAS) and a Verbal Rating Scale (VRS) are currently used in patients with chronic pain. The aim of the present study was to determine which of these two pain tests performs optimally in patients following groin hernia repair.

PATIENTS AND METHODS

A questionnaire identified pain level in a cohort of patients that had previously undergone corrective groin hernia surgery. Current pain intensity was graded on a four-point VRS scale (no pain, mild, moderate or severe pain) and on a 100-mm VAS scale (0=no pain, 100=unbearable). "Scale failure" (one or both tests not completed correctly) was determined, and cut-off points for the VAS test were calculated by creating the optimum kappa coefficient between both tools.

RESULTS

The response rate was 78.2% (706/903). Scale failure was present in VAS tests more than VRS (VAS: 12.5%, 88/706 vs. VRS: 2.8%, 20/706; P<0.001). Advanced age was a risk factor for scale failure (P<0.001). The four categories of VRS corresponded to mean VAS scores of 1, 20, 42, and 78 mm, respectively. VAS categories associated with the highest kappa coefficient (k=0.78) were as follows: 0-8=no pain, 9-32=mild, 33-71=moderate, >71=severe pain. VAS scores grouped per VRS category showed considerable overlap. Age and sex did not significantly influence cut-off points.

CONCLUSIONS

Because of lower scale failure rates and overlapping VAS scores per VRS category, the VRS should be favored over the VAS in future postherniorrhaphy pain assessment. If VAS is preferred, the presented cut-off points should be utilized.

Transinguinal preperitoneal repair with the Polysoft patch: prospective evaluation of recurrence and chronic pain

OBJECTIVE

The Polysoft patch was conceived to facilitate performance of the transinguinal preperitoneal patch method and combine the advantages of patch placement in the preperitoneal space and the open inguinal approach. The aim of this prospective study was to evaluate the rate of recurrence and chronic pain at midterm follow-up.

METHODS

In a cohort of 200 hernia repairs involved in a prospective evaluation, midterm results of 171 cases operated on from 1 July 2004 to 31 December 2005 were assessed. The anesthesia was spinal in 136 (79.5%) cases, local in 26 (15.2%), and general in nine (5.3%). A questionnaire was sent to patients on 30 November 2006 asking about recurrence, chronic groin pain, and satisfaction.

RESULTS

With a median follow-up of 21.9 months (11.6-29.4), 167 (97.7%) patients were evaluated, two were dead, and two were lost to follow-up. There were two (1.2%) recurrences that were reoperated on; both consisted of an indirect sac that protruded between the branches of the split patch. Eleven (6.6%) patients alleged the feeling of a foreign body, and 12 (7.2%) reported pain that occurred occasionally or upon effort but did not prevent activity. In one case, the pain present before operation was unchanged, and in three cases, the pain could clearly be attributed to an origin other than the hernia repair. No case of pain that impaired activity was observed. With regard to results, 98.2% of patients were satisfied and 97.6% declared that they would adopt the same method in case they had to be operated on for another hernia.

CONCLUSION

These results suggest that the technique provides a low rate of recurrence and a low percentage of chronic pain that did not impair activity.

Does delay of hernia repair in minimally symptomatic men burden the patient's family?

BACKGROUND

Although inguinal hernia repair is a common and safe procedure, a significant portion of patients who undergo surgical repair experience postoperative chronic pain. We conducted a clinical trial to determine if delay of repair is a safe and acceptable alternative for men with minimally symptomatic inguinal hernias. Here we report on the effects of delay on the patient's family.

STUDY DESIGN

Data are from a randomized trial in which men with asymptomatic or minimally symptomatic inguinal hernia were randomly assigned to either open tension-free repair (TFR) or watchful waiting (WW). Patients indicated a person who could assist them if necessary because of their hernia or hernia operation, and these persons (mostly spouses) answered a questionnaire at baseline and followup addressing concern about the patient's ability to perform home, social, and recreational activities and time spent assisting the patient with chores because of his hernia condition.

RESULTS

In both intention-to-treat and as-treated analyses, at 2 years after enrollment, family members of patients assigned to WW were more likely to report concern about the patient's ability to perform the four types of activities. But a majority of respondents in both the WW and TFR groups indicated no concern about performance of any of the activities. In the as-treated analysis, family members of patients assigned to TFR who did not receive repair reported more time assisting the patient than those of TFR patients who received the assigned treatment.

CONCLUSIONS

The results favor repair, but the low level of concern about the patient's functioning reported for both TFR and WW patients suggests that this is not a major issue in delaying repair of inguinal hernias in minimally symptomatic men.

Long-term pain after inguinal hernia repair in a population-based cohort; risk factors and interference with daily activities

In the Swedish Hernia Register 2834 inguinal hernia repairs in 2583 patients were registered in the county of Uppsala 1998-2004. In May 2005 the 2421 patients still alive were requested by mail to fill in a validated questionnaire concerning postherniorrhaphy pain. The final response rate became 72%. Altogether 519 patients (29%) stated that they had pain in the operated groin to some extent during past week. In 98 patients (6%) the pain interfered with daily activities. Factors associated with an increased risk of residual pain in a multivariate logistic regression analysis were age below median, operation for recurrence, open repair technique, history of preoperative pain, and less than three years from surgery. Factors not associated with occurrence of residual pain were gender, method of anaesthesia during surgery, hernia sac diameter, postoperative complications, hernia type, need for emergency operation, reducibility of the hernia sac and complete dissection of the hernia sac. Factors found to be associated with impairment of function due to pain in a multivariate logistic regression analysis were: age below median, female gender, medial hernia, open repair technique, postoperative complications, need for operation for recurrence, presence of preoperative pain and less than three years from surgery. The possibility of long-term pain as an outcome after hernia operations should be taken into consideration in the decision making prior to operation.

Quantification of pain in laparoscopic transabdominal preperitoneal (TAPP) inguinal hernioplasty identifies marked differences between prosthesis fixation systems

BACKGROUND

Various systems exist for prosthesis fixation in hernia repair. These techniques vary in terms of postoperative complications and pain. This study compares prosthesis fixation techniques employed in laparoscopic transabdominal preperitoneal (TAPP) hernioplasty using a visual analog scale (VAS) to quantify postoperative pain.

METHODS

Patients (n = 600) underwent TAPP inguinal hernia repair in a randomized prospective study. Prostheses were fixed with Protak (Tyco, Norwalk, Conn), (Group A; n = 150), EndoANCHOR (Ethicon Endo-Surgery, Inc., Cincinnati, Ohio) (Group B; n = 150), EMS (Ethicon Endo-Surgery, Inc.) (Group C; n = 150), or Tissucol (Baxter Healthcare, Milan, Italy) (Group D; n = 150). Patients were interviewed up to 1 month post-intervention. Post-operative pain was evaluated on a 0- to 10-point VAS (0 = no pain, 10 = maximum pain). Morbidity, length of stay, return to work and recurrence were also assessed.

RESULTS

Overall, 803 hernias were treated: 397 patients (66.2%) had unilateral hernias and 203 (33.8%) had bilateral hernias. In total, 96 (12%) hernias were recurrences and 707 (88%) were primary. Postoperative pain ranged from VAS1 to VAS2 (mild pain) between 12 hours and 72 hours with Tissucol (Group D), and it was higher in Groups A-C: Maxima ranged from VAS4 (moderate pain) with EMS to VAS7 (severe pain) with Protak at 48-hour follow-up. Significant differences in length of stay occurred, no recurrence or conversion rates were observed among groups, and morbidity was generally lower with Tissucol. Patients in Group D (Tissucol) also returned to work sooner than did Groups A-C (Protak, EndoANCHOR, and EMS).

CONCLUSIONS

We found differences in postoperative pain among different laparoscopic TAPP prosthesis fixation methods. The use of the biocompatible fibrin sealant Tissucol seems to reduce significantly postoperative pain, complications, and resumption to work times compared with other systems.

Short postal questionnaire and selective clinical examination combined with repeat mailing and telephone reminders as a method of follow-up in hernia surgery

BACKGROUND

We assessed the usefulness of a short postal questionnaire and selective clinical examination combined with repeat mailing and telephone reminders for quality assessment in hernia surgery.

METHODS

All patients (n = 1153) who underwent tension-free hernioplasty through an open preperitoneal approach between 1999 and 2003 received a six-item questionnaire with a covering letter and a stamped addressed envelope. Nonresponders received two successive new questionnaires and a telephone call.

RESULTS

A total of 841 (72.9%) patients returned questionnaires after three reminders (512 after the first mailing, 205 after the second, and 124 after the third). Positive questionnaire answers were documented for 152 (18.1%) of repairs and negative answers for 689 (81.9%). Of the 152 patients who answered "yes" to either of the questions regarding recurrence and/or current pain, 91 declined clinical appointments, 24 could not be contacted by phone, and 37 underwent physical examination. Of the 312 patients who did not return the questionnaire, eight had died, 124 did not want to be visited, and 180 could not be located. The recurrence rate was 2.7% and the chronic pain rate 5.9%.

CONCLUSIONS

Repeat mailing was a useful strategy to improve response to self-administered postal questionnaires on hernia surgery quality assessment. However, contacting the group that responded with positive questionnaire answers was a poorly effective way to encourage subjects to come for a physical examination.

A single-surgeon randomized trial comparing three composite meshes on chronic pain after Lichtenstein hernia repair in local anesthesia

BACKGROUND

Chronic pain may be a long-term problem related to operative trauma and mesh material in Lichtenstein hernioplasty.

STUDY DESIGN

Inguinal hernioplasty was performed under local anesthesia in 228 patients (232 hernias) in day-case surgery by the same surgeon and exactly by the same surgical technique. The patients were randomized to receive either a partly absorbable polypropylene-polyglactin mesh (Vypro II(R) 50 g/m(2), 79 hernias), a lightweight polypropylene mesh (Premilene Mesh LP(R) 55 g/m(2), 75 hernias) or a conventional densely woven polypropylene mesh (Premilene(R) 82 g/m(2), 78 hernias). Pain, patients discomfort and recurrences of hernias were carefully followed at days 1, 7, 1 month, 1 and 2 years after surgery.

RESULTS

The duration of operation (29-33 min) and the amount of local anesthetic (55-57 ml) were similar in the three groups. Two wound infections and four hematomas were detected with no difference between the meshes. Immediate pain reaction up to 1 month was statistically equal among the three meshes. After 2 years of follow-up, there were five recurrences (two in the Vypro group, one in the Premilene LP and two in the Premilene). A feeling of a foreign body, sensation of pain and patient's discomfort were similar with all meshes.

CONCLUSION

There was no difference of pain and quality of life among a conventional polypropylene mesh, lightweight mesh or partly absorbable mesh in 2 years of follow-up, when the same surgeon operated on all patients with exactly the same technique.

Hernia repair with porcine small-intestinal submucosa

PURPOSE

Although at present nonabsorbable meshes are the preferred material for tension-free hernioplasty, some problems with their use have yet to be addressed (i.e., chronic pain and infections). In order to address these disadvantages, a collagen-based material, the porcine small-intestinal submucosa mesh (Surgisis Inguinal Hernia Matrix, Cook Surgical, Bloomington, IN, USA), has recently been developed for hernia repair.

METHODS

With the aim of investigating the clinical safety and effectiveness of Surgisis IHM inguinal hernia repair, we report our experience of 45 consecutive hernioplasties with a medium-term follow-up. The surgical technique for the use of this material in hernioplasty is described in detail.

RESULTS

Although some local (i.e., seromas) and general (i.e., hyperpyrexia), complications appeared in the immediate postoperative period (all of them disappeared spontaneously), no rejection or infection was observed after operations. At the 2-year follow-up, a low degree of pain and discomfort and no recurrences were observed.

CONCLUSIONS

We conclude that the Surgisis IHM hernioplasty is feasible with promising results and, from a clinical perspective, seems safe and effective.

Chronic sequelae of common elective groin hernia repair

BACKGROUND

The aim of this study was to assess long-term chronic pain, numbness and functional impairment after open and laparoscopic groin hernia repair in a teaching hospital.

METHODS

We performed a cross-sectional study in which all adult patients with a groin hernia repair between January 2000 and August 2005 received a questionnaire by post. It contained questions concerning frequency and intensity of pain, presence of bulge, numbness, and functional impairment.

RESULTS

One thousand seven hundred and sixty-six questionnaires were returned (81.6%) and after a median follow-up period of nearly 3 years 40.2% of patients reported some degree of pain. Thirty-three patients (1.9%) experienced severe pain. Almost one-fourth reported numbness which correlated significantly with pain (P < 0.001). Other variables, identified as risk factors for the development of pain were age (P < 0.001) and recurrent hernia repair (P = 0.003). One-fifth of the patients felt functionally impaired in their work or leisure activities.

CONCLUSION

Chronic pain and functional impairment are very common long-term complications after groin herniorrhapy in Dutch teaching hospitals.