1
|
Krpata DM. Management of Chronic Postoperative Inguinal Pain. Surg Clin North Am 2023; 103:889-900. [PMID: 37709394 DOI: 10.1016/j.suc.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2023]
Abstract
Chronic postoperative inguinal pain, CPIP, afflicts 10% to 15% of the nearly 700,000 Americans who have inguinal hernia surgery every year. CPIP is challenging to manage because it poses many diagnostic dilemmas that can be overcome with a thorough history, examination, differential diagnosis, and imaging. The initial treatment of CPIP should explore all nonsurgical therapies including medications, physical therapy, interventional pain management and cognitive therapy. When nonoperative methods fail, surgical interventions including neurectomy and hernia mesh removal have proven to be beneficial for patients with CPIP.
Collapse
Affiliation(s)
- David M Krpata
- Cleveland Clinic Lerner College of Medicine, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
| |
Collapse
|
2
|
Dahlstrand U, Melkemichel M, Österberg J, Montgomery A, de la Croix H. Female Groin Hernia Repairs in the Swedish Hernia Register 1992-2022: A Review With Updates. JOURNAL OF ABDOMINAL WALL SURGERY : JAWS 2023; 2:11759. [PMID: 38312425 PMCID: PMC10831639 DOI: 10.3389/jaws.2023.11759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 09/07/2023] [Indexed: 02/06/2024]
Abstract
Introduction: Groin hernias in women is much less common than in men; it constitutes only 9% of all groin hernia operations. Historically, studies have been performed on men and the results applied to both genders. However, prospectively registered operations within national registers have contributed to new knowledge regarding groin hernias in women. The aim of this paper was to investigate and present a body of literature based upon the Swedish Hernia Register together with recent data from the register's annual report. Patients and Methods: PubMed and Embase were searched for studies based on the Swedish Hernia Register between 1992 and 2023. Based on the initial reading of abstracts, studies that presented results separately for women were selected and read. Recent data were acquired from the 2022 annual report of the Swedish Hernia Register. Results: A total of 73 studies of interest were identified. Of these, 52 included women, but only 19 presented separate results for women. Four themes emerged and were analysed further: emergency surgery and mortality, femoral hernias, the risk of reoperation for recurrence, and chronic pain following female groin hernia repairs. Discussion: Studies from the Swedish Hernia Register clearly describe that both the presentation of hernias and outcomes after repair differ significantly between the two genders. The differences that have been identified over the years have been incorporated into the national guidelines. Register data indicates that the guidelines have been implemented and are fairly well adhered to. As a result, significant improvements in outcomes regarding recurrences have been made for women with groin hernias in Sweden.
Collapse
Affiliation(s)
- Ursula Dahlstrand
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Surgery, Enköping Hospital, Enköping, Sweden
| | - Maria Melkemichel
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
- Department of Surgery, Södertälje Hospital, Södertälje, Sweden
| | - Johanna Österberg
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Surgery, Mora Hospital, Mora, Sweden
| | - Agneta Montgomery
- Department of Clinical Sciences, Malmö, Lund University, Lund, Sweden
| | - Hanna de la Croix
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Surgery, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| |
Collapse
|
3
|
Do postoperative complications correlate to chronic pain following inguinal hernia repair? A prospective cohort study from the Swedish Hernia Register. Hernia 2023; 27:21-29. [PMID: 34894341 PMCID: PMC9931779 DOI: 10.1007/s10029-021-02545-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 11/27/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE To analyse if postoperative complications constitute a predictor for the risk of developing long-term groin pain. METHODS Population-based prospective cohort study of 30,659 patients operated for inguinal hernia 2015-2017 included in the Swedish Hernia Register. Registered post-operative complications were categorised into hematomas, surgical site infections, seromas, urinary tract complications, and acute post-operative pain. A questionnaire enquiring about groin pain was distributed to all patients 1 year after surgery. Multivariable logistic regression analysis was used to find any association between postoperative complications and reported level of pain 1 year after surgery. RESULTS The response rate was 64.5%. In total 19,773 eligible participants responded to the questionnaire, whereof 73.4% had undergone open anterior mesh repair and 26.6% had undergone endo-laparoscopic mesh repair. Registered postoperative complications were: 750 hematomas (2.3%), 516 surgical site infections (1.6%), 395 seromas (1.2%), 1216 urinary tract complications (3.7%), and 520 hernia repairs with acute post-operative pain (1.6%). Among patients who had undergone open anterior mesh repair, an association between persistent pain and hematomas (OR 2.03, CI 1.30-3.18), surgical site infections (OR 2.18, CI 1.27-3.73) and acute post-operative pain (OR 7.46, CI 4.02-13.87) was seen. Analysis of patients with endo-laparoscopic repair showed an association between persistent pain and acute post-operative pain (OR 9.35, CI 3.18-27.48). CONCLUSION Acute postoperative pain was a strong predictor for persistent pain following both open anterior and endo-laparoscopic hernia repair. Surgical site infection and hematoma were predictors for persistent pain following open anterior hernia repair, although the rate of reported postoperative complications was low.
Collapse
|
4
|
Sex Differences, Sleep Disturbance and Risk of Persistent Pain Associated With Groin Hernia Surgery: A Nationwide Register-Based Cohort Study. THE JOURNAL OF PAIN 2021; 22:1360-1370. [PMID: 33964413 DOI: 10.1016/j.jpain.2021.04.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 03/30/2021] [Accepted: 04/14/2021] [Indexed: 02/06/2023]
Abstract
Persistent pain after groin hernia repair is a major health problem. Sleep disturbance is associated with heightened pain sensitivity. The main objective of this study was to examine the role of sleep disturbance in the development and long-term maintenance of chronic postherniorrhaphy inguinal pain (CPIP), with exploration of sex differences. From 2012 to 2017, a national cohort of patients with prior groin hernia repair (n = 2084;45.8% females) were assessed for the development of CPIP 12 months after surgery. Patients then underwent long-term (median 5.0 years) follow-up to evaluate the contribution of sex and sleep disturbance on the maintenance of CPIP. Associations between pre- and postoperative sleep problems (assessed at long-term follow-up) and CPIP were tested using logistic regression. Females had higher rates of CPIP with negative impact on daily activities 12 months after surgery as compared to males (14.6 vs 9.2%, P < .0005), and were more likely to have moderate-severe CPIP in the long-term (3.1 vs 1.2%, P = .003). Preoperative sleep problems predicted development of CPIP 12 months after surgery (adjusted odds ratio [aOR] 1.76 [95%CI 1.26-2.46], P = .001) and CPIP in the long-term (aOR 2.20 [1.61-3.00] , P < .0001). CPIP was associated with insomnia and depression. Sleep disturbance may increase the risk for CPIP, and contribute to maintenance of postsurgical pain. PERSPECTIVE: Females are at heightened risk for CPIP as compared to males. Increased severity of pain symptoms are linked to poorer sleep and psychiatric morbidity. Given the robust associations between sleep disturbance and CPIP, interventions which consolidate and promote sleep, especially in females, may improve long-term pain control.
Collapse
|
5
|
Rutegård M, Lindqvist M, Svensson J, Nordin P, Haapamäki MM. Chronic pain after open inguinal hernia repair: expertise-based randomized clinical trial of heavyweight or lightweight mesh. Br J Surg 2021; 108:138-144. [PMID: 33711123 PMCID: PMC10364858 DOI: 10.1093/bjs/znaa049] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 09/08/2020] [Accepted: 09/20/2020] [Indexed: 11/14/2022]
Abstract
BACKGROUND There is a shortage of high-quality studies regarding choice of mesh in open anterior inguinal hernia repair in relation to long-term chronic pain. The authors hypothesized that heavyweight compared with lightweight mesh causes increased postoperative pain. METHODS An RCT was undertaken between 2007 and 2009 at two sites in Sweden. Men aged 25 years or older with an inguinal hernia evaluated in the outpatient clinic were randomized in an unblinded fashion to heavyweight or lightweight mesh for open anterior inguinal hernia repair. Data on pain affecting daily activities, as measured by the Short-Form Inguinal Pain Questionnaire 9-12 years after surgery, were collected as the primary outcome. Differences between groups were evaluated by generalized odds and numbers needed to treat. RESULTS A total of 412 patients were randomized; 363 were analysed with 320 questionnaires sent out. A total of 271 questionnaires (84.7 per cent) were returned; of these, 121 and 150 patients were in the heavyweight and lightweight mesh groups respectively. Pain affecting daily activities was more pronounced in patients randomized to heavyweight versus lightweight mesh (generalized odds 1.33, 95 per cent c.i. 1.10 to 1.61). This translated into a number needed to treat of 7.06 (95 per cent c.i. 4.28 to 21.44). Two reoperations for recurrence were noted in the heavyweight mesh group, and one in the lightweight mesh group. CONCLUSION A large-pore lightweight mesh causes significantly less pain affecting daily activities a decade after open anterior inguinal hernia repair. Registration number: NCT00451893 (http://www.clinicaltrials.gov).
Collapse
Affiliation(s)
- M Rutegård
- Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden.,Wallenberg Centre for Molecular Medicine, Umeå University, Umeå, Sweden
| | - M Lindqvist
- Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden
| | - J Svensson
- Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden.,Department of Statistics, Umeå School of Business, Economics and Statistics, Umeå University, Umeå, Sweden
| | - P Nordin
- Department of Surgical and Perioperative Sciences, Surgery, Östersund Research Unit, Umeå University, Östersund, Sweden
| | - M M Haapamäki
- Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden
| |
Collapse
|
6
|
Longitudinal cohort study on preoperative pain as a risk factor for chronic postoperative inguinal pain after groin hernia repair at 2-year follow-up. Hernia 2021; 26:189-200. [PMID: 33891224 DOI: 10.1007/s10029-021-02404-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 03/29/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To assess the rate of late chronic postoperative inguinal pain (CPIP) after groin hernia repair in patients with different categories of preoperative VRS (Verbal Rating Scale) pain and to make a pragmatic evaluation of the rates of potentially surgery-related CPIP vs. postoperative continuation of preexisting preoperative pain. METHODS Groin pain of patients operated from 01/11/2011 to 01/04/2014 was assessed preoperatively, postoperatively and at 2-year follow-up using a VRS-4 in 5670 consecutive groin hernia repairs. A PROM (Patient Related Outcomes Measurement) questionnaire studied the impact of CPIP on the patients' daily life. RESULTS Relevant (moderate or severe VRS) pain was registered preoperatively in 1639 of 5670 (29%) cases vs. 197 of 4704 (4.2%) cases at the 2-year follow-up. Among the latter, 125 (3.7%) cases were found in 3353 cases with no-relevant preoperative pain and 72 (5.3%) in 1351 cases with relevant preoperative pain. Relevant CPIP consisted of 179 (3.8%) cases of moderate pain and 18 (0.4%) cases of severe pain. The rate of severe CPIP was independent of the preoperative VRS-pain category while the rate of moderate CPIP (3.1%, 3.4%, 4.1%, 6.8%) increased in line with the preoperative (none, mild, moderate, and severe) VRS-pain categories. The VRS probably overestimated pain since 71.6% of the relevant CPIP patients assessed their pain as less bothersome than the hernia. CONCLUSION At the 2-year follow-up, relevant CPIP was registered in 4.2% cases, of which 63.5% were potentially surgery-related (no-relevant preoperative pain) and 36.5% possibly due to the postoperative persistence of preoperative pain. The rate of severe CPIP was constant around 0.4%.
Collapse
|
7
|
Validation of the Simplified Inguinal Pain Questionnaire for assessing postoperative pain and disability following hernioplasty. Surg Today 2021; 51:1530-1534. [PMID: 33797638 PMCID: PMC8017510 DOI: 10.1007/s00595-021-02275-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 01/02/2021] [Indexed: 11/25/2022]
Abstract
The purpose of this study was to assess the psychometric properties of the Simplified Inguinal Pain Questionnaire (sIPQ) and compare it to the regular Inguinal Pain Questionnaire (IPQ) for external validation. To do so, the IPQ and sIPQ were telephonically administered at 7 and 28 days postoperatively for a cohort of 25 patients who underwent Lichtenstein hernioplasty. A psychometric analysis of the scores was done using Cronbach’s alpha and test–retest assessments. The agreement rate of the mean-standardized values between scores was afterwards calculated. We found closely similar psychometric values for the IPQ and sIPQ. The agreement rate between scores was 97% (p < 0.001). Taken together, the results demonstrate that the sIPQ has psychometric values that are very similar to those of the full IPQ. Its shorter number of items is specifically designed to enable telephonic follow-up and streamline both postoperative care and telemedicine.
Collapse
|
8
|
Gram-Hanssen A, Jessen ML, Christophersen C, Zetner D, Rosenberg J. Trends in the use of patient-reported outcome measures for inguinal hernia repair: a quantitative systematic review. Hernia 2020; 25:1111-1120. [PMID: 33074397 DOI: 10.1007/s10029-020-02322-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 10/07/2020] [Indexed: 01/01/2023]
Abstract
PURPOSE To quantitatively assess the use of patient-reported outcome measures in studies involving patients undergoing inguinal hernia repair. METHODS We performed a systematic literature search in Medline and EMBASE. We included all studies published between 2000 and 2019 that involved > 5 patients receiving inguinal hernia repair and evaluated a postoperative patient-reported outcome measure. Studies were stratified in 5-year intervals. We extracted data on which patient-reported outcome measure was used, its time of administration, study design, and the size and composition of the study population. Data were presented using descriptive statistics. RESULTS We included 929 studies that covered 81 different patient-reported outcome measures. Of these, the Short-Form 36 was the most commonly used generic instrument (14%), the Carolinas Comfort Scale was the most commonly used hernia-specific instrument (5%), and the Visual Analogue Scale was the most commonly used domain-specific instrument (70%). There was a proportional decrease in the use of generic instruments, from 24% of studies in 2000-2004 to only 14% of studies in 2015-2019. Conversely, there was an increase in the use of hernia-specific instruments, from 0% in 2000-2004 to 18% in 2015-2019. CONCLUSIONS There is heterogeneity in the use of patient-reported outcome measures in the field of inguinal hernia research. The use of hernia-specific instruments is increasing, the use of generic instruments is decreasing, and the use of domain-specific instruments remains consistently high. This study serves as a repository of all available patient-reported outcome measures relevant to patients undergoing inguinal hernia repair.
Collapse
Affiliation(s)
- A Gram-Hanssen
- Center for Perioperative Optimization, Department of Surgery, Herlev Hospital, University of Copenhagen, Herlev, Denmark.
| | - M L Jessen
- Center for Perioperative Optimization, Department of Surgery, Herlev Hospital, University of Copenhagen, Herlev, Denmark
| | - C Christophersen
- Center for Perioperative Optimization, Department of Surgery, Herlev Hospital, University of Copenhagen, Herlev, Denmark
| | - D Zetner
- Center for Perioperative Optimization, Department of Surgery, Herlev Hospital, University of Copenhagen, Herlev, Denmark
| | - J Rosenberg
- Center for Perioperative Optimization, Department of Surgery, Herlev Hospital, University of Copenhagen, Herlev, Denmark
| |
Collapse
|
9
|
A registry-based 2-year follow-up comparative study of two meshes used in transinguinal preperitoneal (TIPP) groin hernia repair. Langenbecks Arch Surg 2020; 406:197-208. [PMID: 32997233 DOI: 10.1007/s00423-020-01993-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 09/22/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Onflex™ mesh has replaced Polysoft™ patch on the market, without being clinically evaluated thus far in the transinguinal preperitoneal (TIPP) technique. METHODS All consecutive TIPP registered in our registry during the overlap period of availability of both meshes were included and studied with the chronic postoperative inguinal pain (CPIP) as primary endpoint, assessed with a verbal rating scale (VRS), and included in a patient-related outcome measurement (PROM) phone questionnaire. RESULTS A total of 181 Onflex cases vs 182 Polysoft cases were studied with a 2-year follow-up rate of 92% vs 88%. The overall rate of pain or discomfort was not statistically different in the 2 studied subgroups (16.5% vs 17.6%; p = 0.71), while moderate or severe pain were significantly more frequent in the Polysoft subgroup (5.5% vs 11.6%; p = 0.01). These symptoms did not interfere with the patient daily life in 16% vs 16.5% of cases, and they were self-assessed as more bothersome than the hernia in only 0.5% vs 0.5% of cases, suggesting an overestimation of the pain by the VRS. Patients assessed the result of their hernia repair as excellent or good in 97.8% vs 96.7% and medium or bad in 2.2% vs 3.3% (p = 0.53). The cumulative recurrence rate was 0% vs 2.2%. Two reoperations (one for early and one for late recurrence) were reported in the Polysoft subgroup (1%), none related to the non-absorbable memory ring. CONCLUSIONS These results suggest that TIPP with Onflex provides results at least similar than those with Polysoft.
Collapse
|
10
|
Melkemichel M, Bringman S, Nilsson H, Widhe B. Patient-reported chronic pain after open inguinal hernia repair with lightweight or heavyweight mesh: a prospective, patient-reported outcomes study. Br J Surg 2020; 107:1659-1666. [PMID: 32614470 DOI: 10.1002/bjs.11755] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 03/24/2020] [Accepted: 05/12/2020] [Indexed: 11/11/2022]
Abstract
BACKGROUND Chronic pain after groin hernia repair is a significant problem, and it is unclear whether or not lightweight meshes help. This national register-based study investigated whether patients who underwent open anterior mesh inguinal hernia repair with lightweight mesh had less chronic pain than those who had hernia repair with heavyweight mesh. METHODS All patients registered in the Swedish Hernia Register between September 2012 and October 2016 were asked to complete a questionnaire assessing patient-reported outcome measures 1 year after surgery. The present study examined open anterior repair with mesh sutured in place with non-absorbable sutures in male patients only. The primary endpoint, chronic pain, was defined as pain present in the past week that could not be ignored and interfered with concentration (on chores) and daily activities. RESULTS In total, 23 259 male patients provided data for analysis (response rate 70·6 per cent). Rates of chronic pain after repairs using regular polypropylene lightweight mesh, composite (poliglecaprone-25) polypropylene lightweight mesh and polypropylene heavyweight mesh were 15·8, 15·6 and 16·2 per cent respectively. Adjusted multiple logistic regression analysis showed no significant differences between regular (odds ratio (OR) 0·98, 95 per cent c.i. 0·90 to 1·06) or composite (OR 0·95, 0·86 to 1·04) lightweight mesh versus heavyweight mesh. The most striking risk factor for chronic pain was young age; 19·4 per cent of patients aged less than 50 years experienced pain 1 year after hernia repair (OR 1·43, 1·29 to 1·60). CONCLUSION Patient-reported chronic pain 1 year after open mesh repair of inguinal hernia was common, particularly in young men. The risk of developing chronic pain was not influenced by the type of mesh.
Collapse
Affiliation(s)
- M Melkemichel
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.,Department of Surgery, Södertälje, Hospital, Stockholm, Sweden
| | - S Bringman
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.,Department of Surgery, Södertälje, Hospital, Stockholm, Sweden
| | - H Nilsson
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg, Sweden.,Region Västra Götaland, Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - B Widhe
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.,Department of Surgery, Södertälje, Hospital, Stockholm, Sweden
| |
Collapse
|
11
|
Gram-Hanssen A, Tolstrup A, Zetner D, Rosenberg J. Patient-reported outcome measures for inguinal hernia repair are insufficiently validated: a systematic review. Int J Qual Health Care 2020; 32:223-230. [PMID: 32211859 DOI: 10.1093/intqhc/mzaa019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 11/25/2019] [Accepted: 01/29/2020] [Indexed: 12/11/2022] Open
Abstract
PURPOSE To systematically assess the validity of patient-reported outcome measures (PROMs) for patients undergoing inguinal hernia repair. DATA SOURCES A systematic review was performed according to the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guideline for systematic reviews of PROMs. PubMed, EMBASE and PsycINFO were consulted. STUDY SELECTION Only studies explicitly aimed at validation of PROMs specific for patients with inguinal hernia were included. DATA EXTRACTION Data regarding measurement properties of PROMs were extracted from the included studies. Each study was critically assessed for methodological quality and each PROM was evaluated for sufficient measurement properties. RESULTS OF DATA SYNTHESIS We included 15 studies, covering 11 different PROMs. The Carolinas Comfort Scale was the most frequently investigated PROM, being covered in five of the included publications. The included PROMs were evaluated according to nine different measurement properties, of which internal consistency and construct validity were the most frequently assessed. Evidence regarding content validity and structural validity was universally inadequate, according to the criteria for good measurement properties, as defined by the COSMIN. CONCLUSION Based on the current evidence, it is not possible to formulate recommendations for application of PROMs for patients undergoing inguinal hernia repair. Further validation of the included PROMs is necessary especially regarding content validity and structural validity.
Collapse
Affiliation(s)
- Anders Gram-Hanssen
- Center for Perioperative Optimization, Department of Surgery, Herlev Hospital, University of Copenhagen, Herlev Ringvej 75, DK-2730 Herlev, Denmark
| | - Anders Tolstrup
- Center for Perioperative Optimization, Department of Surgery, Herlev Hospital, University of Copenhagen, Herlev Ringvej 75, DK-2730 Herlev, Denmark
| | - Dennis Zetner
- Center for Perioperative Optimization, Department of Surgery, Herlev Hospital, University of Copenhagen, Herlev Ringvej 75, DK-2730 Herlev, Denmark
| | - Jacob Rosenberg
- Center for Perioperative Optimization, Department of Surgery, Herlev Hospital, University of Copenhagen, Herlev Ringvej 75, DK-2730 Herlev, Denmark
| |
Collapse
|
12
|
Özveri E, Şanlı DET, Yıldırım D, Gök H, Ertem M. Magnetic resonance visualization of iron-loaded meshes in patients with pain after inguinal hernia repair. Hernia 2020; 25:727-732. [PMID: 32166710 DOI: 10.1007/s10029-020-02168-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 03/02/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Chronic post-operative inguinal pain (CPIP) is defined as pain lasting more than 3 months and the incidence is less than 4% after laparoscopic hernia repair. CPIP can have several causes. In this study, we aimed to show that 3D-iron loaded mesh preparations are useful in radiological evaluation of post-operative complications, especially patients with chronic pain and the mesh status of operated inguinal hernia cases. METHODS A total of 450 cases who had been operated for inguinal hernia with 3D-iron loaded mesh and who had ongoing pain at the post-operative period were included in this study. MRI (Magnetic Resonance Imaging) was performed at the post-operative 90th day of the seven symptomatic (groin pain, limitation of movement) cases which were operated using a 3D-iron loaded mesh, 10 × 15 cm in size, (DynaMeshEndolap visible with 25% MRI-visible filaments, FEG TextiltechnikmbH, Aachen, Germany) for inguinal hernia repair to evaluate mesh status, localization, and local complications. Gradient echo sequences in the sagittal, axial, and coronal sections on MRI were discussed by two radiologists. Mesh localizations, their relationship with surrounding structures and their complications related with mesh were evaluated by two radiologists (D.Y, D.E.T.Ş). RESULTS No significant radiological findings related to defined anatomical structures were found in the MRI images of the study group. The dimensions measured on the sagittal, axial and coronal images were correlated with original mesh sizes and no significant shrinkage was detected. CONCLUSION Mesh position and deformation as shrinkage can be the mesh-related cause of pain. The incidence of CPIP in our patients is less than 2%. 3D-iron loaded meshes were monitored with MRI in CPIP patients and there was no mesh-related changes found in our study. The use of MRI-visible meshes will most likely help us to monitor mesh preparations and show potential time-dependent changes in mesh characteristics and consequent complications. In case of doubtful clinical postoperative hernia recurrence or chronic groin pain, mesh position can be identified by MRI and unnecessary surgical intervention can be avoided.
Collapse
Affiliation(s)
- E Özveri
- Department of Surgery, Acıbadem Hospital, Kozyatağı, Istanbul, Turkey.
| | - D E T Şanlı
- Department of Radiology, Acıbadem Hospital, Kozyatağı, Istanbul, Turkey
| | - D Yıldırım
- Department of Radiology, Acıbadem Hospital, Kozyatağı, Istanbul, Turkey
| | - H Gök
- Department of Surgery, Acıbadem Hospital, Kozyatağı, Istanbul, Turkey
| | - M Ertem
- Department of Surgery, Acıbadem Hospital, Kozyatağı, Istanbul, Turkey
| |
Collapse
|
13
|
Polyakov AA, Mikhin IV, Kosivtsov OA, Ryaskov LA. [Positioning of mesh implants in endoscopic inguinal hernia repair]. Khirurgiia (Mosk) 2020:53-59. [PMID: 32573533 DOI: 10.17116/hirurgia202006153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To improve the results of endoscopic inguinal hernia repair by determining the optimal access to inguinal region and method of positioning of the mesh implant. MATERIAL AND METHODS There were 221 patients with inguinal hernia who underwent 278 operations. We formed 2 groups: the main group A consisted of 92 (41.6%) patients who underwent extraperitoneal interventions (TEP/e-TEP); the control group B - 129 (58.4%) patients after transabdominal surgery (TAPP). In each group, 3 subgroups were identified depending on the method of mesh implant positioning: subgroups A1 and B1 - stapler reduced fixation at 1-3 points, subgroups A2 and B2 - glue fixation, subgroups A3 and B3 - vacuum positioning without fixation. Acute, chronic pain syndrome and quality of life were evaluated using visual-analogue scale (VAS), Short-Form Inguinal Pain Questionnaire (sf-IPQ) and SF-36 questionnaire, respectively. RESULTS All interventions were completed in minimally invasive fashion. Regression of acute pain syndrome after 3, 24, 48, 72 hours and 7 days was as follows: in group A - from 3.39±0.37 to 0.53±0.18 scores, in group B - from 4.47±0.34 to 0.94±0.24 scores. The lowest values were observed in subgroups with non-invasive positioning (p<0.05). Chronic pain syndrome was evaluated by all patients as less than 2 scores in 6 months after surgery. SF-36 values after 6 months ranged from 78±1.5 to 92±1.0 at TEP/e-TEP and from 75±1.6 to 92±1.1 at TAPP. Between-group and within-group differences were not significant (p>0.05). Control examination within 0.5-2 years was performed in 189 (85.5%) patients. No relapses were detected. CONCLUSION E-TEP technology is a priority. Glue fixation increases the congruence of mesh implants with inguinal region due to enlarged area of immobilization. This ensures safety and reliability of hernia repair, comfort for patients.
Collapse
Affiliation(s)
- A A Polyakov
- Volgograd State Medical University of the Ministry of Health of Russia, Volgograd, Russia
| | - I V Mikhin
- Volgograd State Medical University of the Ministry of Health of Russia, Volgograd, Russia
| | - O A Kosivtsov
- Volgograd State Medical University of the Ministry of Health of Russia, Volgograd, Russia
| | - L A Ryaskov
- Volgograd State Medical University of the Ministry of Health of Russia, Volgograd, Russia
| |
Collapse
|
14
|
Erivan R, Villatte G, Chaput T, Mulliez A, Ollivier M, Descamps S, Boisgard S. French translation and cultural adaptation of a questionnaire for patients with hip or knee prosthesis. Orthop Traumatol Surg Res 2019; 105:435-440. [PMID: 30858043 DOI: 10.1016/j.otsr.2019.01.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 01/08/2019] [Accepted: 01/11/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The Kingsbury questionnaire offers the possibility of follow-up by means of an X-ray and a simple questionnaire sent to the home address of the patient, who will not need to come in consultation if there are no problems. The questionnaire detects any anomaly in follow-up. In case of anomaly in the questionnaire or radiograph, the patient is contacted and/or seen again, as appropriate. The Kingsbury questionnaire has had no transcultural validation, and we therefore conducted a prospective study in order to 1) translate into French the questionnaire, previously validated in English; 2) adapt it for good understanding according to cultural habits; and 3) assess the translated version on a test-retest procedure. HYPOTHESIS The study hypothesis was that the translated questionnaire would show good test-retest reproducibility. MATERIAL AND METHODS The exact English version of the questionnaire was obtained directly from the authors of the index publication. A methodology of translation, back-translation and test-retest enabled assessment of the translation and of the reproducibility of the French version. The reference method of cultural adaptation of self-administered questionnaires and patient information documents was used. The questionnaire was tested prospectively. RESULTS One hundred patients were contacted, providing 73 clinical tests with radiographic validation and 48 complete test-retests in a representative population of total hip and total knee arthroplasty (THA, TKA). Internal coherence showed a KR-20 coefficient of 0.71 and Cronbach alpha of 0.76: e.g., good internal coherence. Item difficulty, requiring renewed contact, was low for all questions. Mean variance was low on the first 7 questions: 0.08 (range, 0.02-0.16). Correlation was close to 0.5 for each question. Analysis of reproducibility found excellent agreement (>90%) for the first 7 questions, which were binary; for question 8, agreement was good (83.3%) considering that there were 5 possible responses. For 19 of the 73 respondents, the questionnaire results indicated a need for further contact. After analysis of their radiographs, 4 needed to be seen in consultation again. The other 15 had unfavorable responses but without deterioration since the last classical consultation or any radiologic abnormality consultation, and were not called back for consultation. CONCLUSION The French version of the Kingsbury questionnaire provided reproducible assessment, avoiding the need to call the patient back for consultation unnecessarily. The questionnaire needs validating in a larger sample before being widely used: the present study was just a first step. LEVEL OF EVIDENCE IV, Prospective without control group.
Collapse
Affiliation(s)
- Roger Erivan
- Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, ICCF, 63000 Clermont-Ferrand, France.
| | - Guillaume Villatte
- Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, ICCF, 63000 Clermont-Ferrand, France
| | - Thibault Chaput
- Université Clermont Auvergne, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - Aurélien Mulliez
- Délégation à la Recherche Clinique et aux Innovations (DRCI) - CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - Matthieu Ollivier
- Aix-Marseille Université, CNRS, ISM UMR 7287, 13288, Marseille cedex 09, France Institute for Locomotion, Department of Orthopedics and Traumatology, St. Marguerite Hospital, 270, boulevard Sainte-Marguerite, BP 29, 13274 Marseille, France
| | - Stéphane Descamps
- Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, ICCF, 63000 Clermont-Ferrand, France
| | - Stéphane Boisgard
- Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, ICCF, 63000 Clermont-Ferrand, France
| |
Collapse
|