Risk Factors for Reoperation Due to Chronic Groin Postherniorrhaphy Pain

Overview

Journal Hernia

Publisher Springer

Date 2015 Aug 5

PMID 26238397

Citations 6

Authors

M Hallen

D Sevonius

J Westerdahl

U Gunnarsson

G Sandblom

Affiliations

Soon will be listed here.

Abstract

Background: Chronic groin postherniorrhaphy pain (CGPP) is common and sometimes so severe that surgical treatment is necessary. The aim of this study was to identify risk factors for being reoperated due to CGPP.

Methods: All 195,707 repairs registered in the Swedish Hernia Register between 1999 and 2011 were included in the study. Out of these, 28,947 repairs were excluded since they were registered as procedures on the same patient after a previous repair. Age, gender, hernia anatomy (indirect reference), method of repair (anterior sutured repair reference) and postoperative complications were included in a multivariate Cox analysis with reoperation due to CGPP as endpoint.

Results: Of the patients included in the study cohort, 218 (0.13%) later underwent reoperation due to CGPP, including 31 (14%) women. Median age at the primary repair was 61.5 years. Risk factors for being reoperated were age < median [hazard ratio (HR) 3.03, 95% confidence interval (CI) 2.22-4.12], female gender (HR 2.13, CI 1.41-3.21), direct hernia (HR 1.35, CI 1.003-1.81), other hernia (HR 6.03, CI 3.08-11.79), Lichtenstein repair (HR 2.22, CI 1.16-4.25), plug repair (HR 3.93, CI 1.96-7.89), other repair (HR 2.58, CI 1.08-6.19), bilateral repair (HR 2.58, CI 1.43-4.66) and postoperative complication (HR 4.40, CI 3.25-5.96).

Conclusions: Risk factors for being reoperated due to CGPP in this cohort included low age, female gender, a direct hernia, a previous Lichtenstein or plug repair, bilateral repair and postoperative complications. Further research on how to avoid CGPP and explore the effectiveness of surgery for CGPP is necessary.

Citing Articles

Female Groin Hernia Repairs in the Swedish Hernia Register 1992-2022: A Review With Updates.

Dahlstrand U, Melkemichel M, Osterberg J, Montgomery A, de la Croix H J Abdom Wall Surg. 2024; 2:11759.

PMID: 38312425 PMC: 10831639. DOI: 10.3389/jaws.2023.11759.

Minimizing complications following transinguinal preperitoneal modified Kugel mesh herniorrhaphy: a double blind prospective randomized clinical trial.

Chiang H, Lin J, Chen J, Hsu Y, Chen P Sci Rep. 2022; 12(1):16370.

PMID: 36180567 PMC: 9525261. DOI: 10.1038/s41598-022-20803-6.

Prophylaxis and treatment of acute and chronic postoperative inguinal pain (CPIP)-association of pain with compression neuropathy.

Holzheimer R, Gaschutz N J Surg Case Rep. 2020; 2020(7):rjaa143.

PMID: 32699595 PMC: 7365039. DOI: 10.1093/jscr/rjaa143.

Data and outcome of inguinal hernia repair in hernia registers - a review of the literature.

Kockerling F Innov Surg Sci. 2019; 2(2):69-79.

PMID: 31579739 PMC: 6754003. DOI: 10.1515/iss-2016-0206.

Risk factors of chronic pain after inguinal hernia repair: a systematic review.

Reinpold W Innov Surg Sci. 2019; 2(2):61-68.

PMID: 31579738 PMC: 6754000. DOI: 10.1515/iss-2017-0017.

References

Schafer M . Chronic groin pain after open, transabdominal preperitoneal and totally extraperitoneal hernia repair. World J Surg. 2010; 34(4):697-8. DOI: 10.1007/s00268-010-0440-5. View

Aasvang E, Kehlet H . Chronic postoperative pain: the case of inguinal herniorrhaphy. Br J Anaesth. 2004; 95(1):69-76. DOI: 10.1093/bja/aei019. View

Poobalan A, Bruce J, Smith W, King P, Krukowski Z, Chambers W . A review of chronic pain after inguinal herniorrhaphy. Clin J Pain. 2003; 19(1):48-54. DOI: 10.1097/00002508-200301000-00006. View

Droeser R, Dell-Kuster S, Kurmann A, Rosenthal R, Zuber M, Metzger J . Long-term follow-up of a randomized controlled trial of Lichtenstein's operation versus mesh plug repair for inguinal hernia. Ann Surg. 2013; 259(5):966-72. DOI: 10.1097/SLA.0000000000000297. View

Simons M, Aufenacker T, Bay-Nielsen M, Bouillot J, Campanelli G, Conze J . European Hernia Society guidelines on the treatment of inguinal hernia in adult patients. Hernia. 2009; 13(4):343-403. PMC: 2719730. DOI: 10.1007/s10029-009-0529-7. View

Aasvang E, Gmaehle E, Hansen J, Gmaehle B, Forman J, Schwarz J . Predictive risk factors for persistent postherniotomy pain. Anesthesiology. 2010; 112(4):957-69. DOI: 10.1097/ALN.0b013e3181d31ff8. View

Grant A . Laparoscopic versus open groin hernia repair: meta-analysis of randomised trials based on individual patient data. Hernia. 2002; 6(1):2-10. DOI: 10.1007/s10029-002-0050-8. View

Aasvang E, Bay-Nielsen M, Kehlet H . Pain and functional impairment 6 years after inguinal herniorrhaphy. Hernia. 2006; 10(4):316-21. DOI: 10.1007/s10029-006-0098-y. View

Campanelli G, Bertocchi V, Cavalli M, Bombini G, Biondi A, Tentorio T . Surgical treatment of chronic pain after inguinal hernia repair. Hernia. 2013; 17(3):347-53. DOI: 10.1007/s10029-013-1059-x. View

10.

Nienhuijs S, Rosman C . Long-term outcome after randomizing prolene hernia system, mesh plug repair and Lichtenstein for inguinal hernia repair. Hernia. 2014; 19(1):77-81. DOI: 10.1007/s10029-014-1295-8. View

11.

Schmedt C, Sauerland S, Bittner R . Comparison of endoscopic procedures vs Lichtenstein and other open mesh techniques for inguinal hernia repair: a meta-analysis of randomized controlled trials. Surg Endosc. 2004; 19(2):188-99. DOI: 10.1007/s00464-004-9126-0. View

12.

Grant A . Open mesh versus non-mesh repair of groin hernia: meta-analysis of randomised trials based on individual patient data [corrected]. Hernia. 2002; 6(3):130-6. DOI: 10.1007/s10029-002-0073-1. View

13.

Franneby U, Sandblom G, Nordin P, Nyren O, Gunnarsson U . Risk factors for long-term pain after hernia surgery. Ann Surg. 2006; 244(2):212-9. PMC: 1602172. DOI: 10.1097/01.sla.0000218081.53940.01. View

14.

Courtney C, Duffy K, Serpell M, ODwyer P . Outcome of patients with severe chronic pain following repair of groin hernia. Br J Surg. 2002; 89(10):1310-4. DOI: 10.1046/j.1365-2168.2002.02206.x. View

15.

Berndsen F, Petersson U, Arvidsson D, Leijonmarck C, Rudberg C, Smedberg S . Discomfort five years after laparoscopic and Shouldice inguinal hernia repair: a randomised trial with 867 patients. A report from the SMIL study group. Hernia. 2007; 11(4):307-13. DOI: 10.1007/s10029-007-0214-7. View

16.

Alfieri S, Amid P, Campanelli G, Izard G, Kehlet H, Wijsmuller A . International guidelines for prevention and management of post-operative chronic pain following inguinal hernia surgery. Hernia. 2011; 15(3):239-49. DOI: 10.1007/s10029-011-0798-9. View

17.

Kehlet H, Roumen R, Reinpold W, Miserez M . Invited commentary: Persistent pain after inguinal hernia repair: what do we know and what do we need to know?. Hernia. 2013; 17(3):293-7. DOI: 10.1007/s10029-013-1109-4. View

18.

Bischoff J, Enghuus C, Werner M, Kehlet H . Long-term follow-up after mesh removal and selective neurectomy for persistent inguinal postherniorrhaphy pain. Hernia. 2013; 17(3):339-45. DOI: 10.1007/s10029-013-1073-z. View

19.

. Repair of groin hernia with synthetic mesh: meta-analysis of randomized controlled trials. Ann Surg. 2002; 235(3):322-32. PMC: 1422456. DOI: 10.1097/00000658-200203000-00003. View

20.

Bringman S, Conze J, Cuccurullo D, Deprest J, Junge K, Klosterhalfen B . Hernia repair: the search for ideal meshes. Hernia. 2009; 14(1):81-7. PMC: 2815300. DOI: 10.1007/s10029-009-0587-x. View