O11 SEX DIFFERENCES, SLEEP DISTURBANCE AND RISK OF PERSISTENT PAIN ASSOCIATED WITH GROIN HERNIA SURGERY: A NATIONWIDE REGISTER-BASED COHORT STUDY

Abstract Aim 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. Material and Methods From 2012-2017, 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. Results 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<0.0005), and were more likely to have moderate-severe CPIP in the long-term (3.1 vs 1.2%, p=0.003). Preoperative sleep problems predicted development of CPIP 12 months after surgery (adjusted odds ratio (aOR) 1.76 (95%CI 1.26-2.46), p=0.001) and CPIP in the long-term (aOR 2.20 (1.61-3.00), p<0.0001). CPIP was associated with insomnia and depression. Conclusions Sleep disturbance may increase the risk for CPIP, and contribute to maintenance of postsurgical pain. Females are at heightened risk for CPIP as compared to males. Given the robust associations between sleep disturbance and CPIP, interventions which consolidate and promote sleep, especially in females, may improve long-term pain control.

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Laparoscopic repair of inguinal hernia: Prospective evaluation at a tertiary care center

Journal of Surgical Sciences ◽

10.3329/jss.v23i2.46111 ◽

2020 ◽

Vol 23 (2) ◽

pp. 54-58

Author(s):

ABM Mahbubur Rahman ◽

Tamjeed Alam ◽

AHM Shamsul Alam ◽

Fahim Ferdaus ◽

Gazi Gias Uddin

Keyword(s):

Chronic Pain ◽

Inguinal Hernia ◽

Hernia Repair ◽

Groin Hernia ◽

Tertiary Care ◽

Groin Hernia Repair ◽

Groin Hernias ◽

Laparoscopic Groin Hernia Repair ◽

Repair Techniques

Background: Treatment of groin hernias continues to evolve. The emergence of laparoscopic inguinal hernia surgery has challenged the conventional gold standard Lichtenstein’s tension free mesh repair. Laparoscopic technique to achieve surgical correction over groin hernia is increasingly being practiced in our country, and it is imperative to test the overall outcome of this technique in a tertiary care setting. Objectives: Current study was aimed at evaluating the per-operative events, early and late outcomes of laparoscopic groin hernia repair techniques. End points of evaluation were postoperative pain, hospital stay, resumption of normal activities, chronic pain and recurrence. Methods: Within a 2-year period, 45 patients of groin hernias of different clinical types underwent laparoscopic inguinal hernia repair in Bangladesh Medical College Hospital were recruited in this prospective observational study. Preoperative findings, intraoperative course, postoperative and follow-up data were analyzed to evaluate the outcomes. Observations were made regarding operating time, operative hazards, postoperative pain, incidence of early post-operative morbidities, hospital stay, resumption of activities. Total 24 months follow-up was carried out with regards to normal activity, late complications notably chronic groin pain and recurrence. Results: The mean age of 38.1±11.1 years, 27(60%) patients underwent TEP repair whereas, TAPP procedure was carried out in 18 patients (40%). For unilateral hernia repair using TEP technique, mean operative time was 50.3±4.2 mints and 61.7±5.3 mints for direct and indirect variety (D/I), with the corresponding rates for TAPP repair being 65.0±2.2 mints and 72.8±3.2 mints (D/I) respectively. Conversion rate to other operative procedure was 6.67%. The overall surgery related early post-operative morbidity was 7.4% (TEP) and 16.8% (TAPP). 3 out of 45 patients (6.67%) experienced chronic pain in the groin in the study. However, there was no single incidence of recurrence observed during the follow up period. Conclusion: Laparoscopic groin hernia repair techniques are safe and feasible, offers the benefits of minimally invasive surgery and becoming the procedure of choice specially for bilateral and recurrent inguinal hernias. Journal of Surgical Sciences (2019) Vol. 23(2): 54-58

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