scholarly journals A Simplified Clinical Algorithm for Standardized Surgical Treatment of Chronic Pain After Inguinal Hernia Repair: A Quality Assessment Study

2020 ◽  
pp. 145749692095457
Author(s):  
K. F. Pedersen ◽  
D. C. Chen ◽  
H. Kehlet ◽  
M. W. Stadeager ◽  
T. Bisgaard
Keyword(s):  
Chronic Pain ◽  
Inguinal Hernia ◽  
Surgical Treatment ◽  
Hernia Repair ◽  
Inguinal Hernia Repair ◽  
Functional Impairment ◽  
Assessment Scale ◽  
Secondary Outcome ◽  
Clinical Algorithm ◽  
Activity Assessment

Background: The optimal surgical strategy for the treatment of chronic pain after inguinal hernia repair is controversial and based on relatively weak evidence. The purpose of this study was to analyze pain-related functional impairment using a simplified clinical treatment algorithm for a standardized surgical treatment. The algorithm was predefined, and the indication to operate was based on strict criteria. Methods: This was a prospective, non-controlled, explorative study. The pain operation was either open triple neurectomy with total mesh removal or laparoscopic retroperitoneal triple neurectomy. A clinically relevant postoperative change was defined as ⩾25% change from the baseline level. Primary outcome was pain-related impairment of physical function using the Activity Assessment Scale. Secondary outcomes included Individual Patient-Reported Outcome Measures, Hospital Anxiety and Depression Scale, and PainDETECT Questionnaire. Results: A total of 240 patients were referred (2016–2019). Sixty-six patients were included for the analysis. A total of 25% of referred patients were offered a pain operation. Follow-up was a median 3 months (range: 3–13). Activity Assessment Scale scores were clinically relevant improved in 43 patients (68%), not clinically relevant different in 19 (30%), and clinically relevant worsened in one (2%). Secondary outcome scores were all significantly improved ( P < 0.05) except for the risk of postoperative depression ( P = 0.092). Fifty-one patients (77%) reported that chronic groin pain was reduced after the operation. Conclusion: Pain-related functional impairment was improved with clinical relevance in roughly 70% of patients through a simplified clinical algorithm for surgical treatment of severe chronic pain after an inguinal hernia repair.

scholarly journals Nationwide Results on Chronic Pain After Bilateral Transabdominal Preperitoneal Inguinal Hernia Repair

2019 ◽  
Vol 109 (4) ◽  
pp. 289-294
Author(s):  
N. Johansen ◽  
C. D. Vyrdal ◽  
T. Bisgaard
Keyword(s):  
Inguinal Hernia ◽  
Hernia Repair ◽  
Inguinal Hernia Repair ◽  
Performance Status ◽  
Assessment Scale ◽  
Activity Assessment ◽  
Transabdominal Preperitoneal ◽  
Inguinal Pain ◽  
Chronic Postoperative Inguinal Pain ◽  
Transabdominal Preperitoneal Inguinal Hernia

Background: Majority of studies on chronic postoperative inguinal pain has described the occurrence after unilateral inguinal hernia repair. Endo-laparoscopic repair, for example, laparoscopic transabdominal preperitoneal inguinal hernia repair, has been recommended for primary bilateral symptomatic inguinal hernias, although the literature on chronic postoperative inguinal pain among this type of patients is limited. The present study analyzed chronic postoperative inguinal pain following bilateral transabdominal preperitoneal inguinal hernia repair. Methods: Nationwide consecutive patients who underwent bilateral transabdominal preperitoneal inguinal hernia repair (July 2012–June 2013) were recruited from the Danish Inguinal Hernia Database and cross-checked with hospital files and the National Patient Registry. A prospective follow-up was performed with a standardized postal questionnaire including questions on functional performance status assessed by a modified version of the Activity Assessment Scale. The primary outcome was incidence of chronic postoperative inguinal pain defined as moderate to severe pain-related impairment of everyday activities. Pain was registered according to the two individual groin areas. Furthermore, the overall incidence of chronic postoperative inguinal pain per operated inguinal hernia was calculated. Intensity of experienced pain (Activity Assessment Scale score) was compared between patients reporting pain from one versus both groin areas. Results: In total, 209 patients (418 hernia repairs) were analyzed (questionnaire response rate 83%). The median follow-up time was 27 months (22–34 months). In total, 27 of 209 patients (13%) complained of chronic postoperative inguinal pain from either one ( n = 17) or both ( n = 10) groin areas after bilateral transabdominal preperitoneal inguinal hernia repair. The incidence of chronic inguinal pain per operated hernia was 9%. The intensity of impairment due to pain (Activity Assessment Scale score) did not differ significantly between patients with chronic postoperative inguinal pain in one (19%) versus both sides (30%), p = 0.056. Conclusion: Bilateral transabdominal preperitoneal inguinal hernia repair for symptomatic inguinal hernias was related to a high incidence (13%) of chronic postoperative inguinal pain and decreased functional performance status.

Surgical treatment of chronic pain after inguinal hernia repair

Hernia ◽  
2013 ◽  
Vol 17 (3) ◽  
pp. 347-353 ◽  
Author(s):  
G. Campanelli ◽  
V. Bertocchi ◽  
M. Cavalli ◽  
G. Bombini ◽  
A. Biondi ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Inguinal Hernia ◽  
Surgical Treatment ◽  
Hernia Repair ◽  
Inguinal Hernia Repair

Inguinal Hernia Repair Using Self-adhering Sutureless Mesh: Adhesix™: A 3-Year Follow-up with Low Chronic Pain and Recurrence Rate

2016 ◽  
Vol 82 (2) ◽  
pp. 112-116 ◽  
Author(s):  
Malek Tabbara ◽  
Laurent Genser ◽  
Manuela Bossi ◽  
Maxime Barat ◽  
Claude Polliand ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Inguinal Hernia ◽  
Postoperative Pain ◽  
Postoperative Complications ◽  
Hernia Repair ◽  
Inguinal Hernia Repair ◽  
Recurrence Rate ◽  
Initial Surgery ◽  
Complications Rate

To review our experience and outcomes after inguinal hernia repair using the lightweight self-adhering sutureless mesh “Adhesix™” and demonstrate the safety and efficacy of this mesh. This is a 3-year retrospective study that included 143 consecutive patients who underwent 149 inguinal hernia repairs at our department of surgery. All hernias were repaired using a modified Lichtenstein technique. Preoperative, perioperative, and postoperative data were prospectively collected. Incidence of chronic pain, postoperative complications, recurrence, and patient satisfaction were assessed three years postoperatively by conducting a telephone survey. We had 143 patients with a mean age of 58 years (17–84), who underwent 149 hernia repairs using the Adhesix™ mesh. Ninety-two per cent (131 patients) were males. Only 10 patients (7%) had a postoperative pain for more than three years. In our series, neither age nor gender was predictive of postoperative pain. Only one patient had a hematoma lasting for more than one month and only four patients (2.8%) had a recurrence of their hernia within three years of their initial surgery. Ninety per cent of the patient expressed their satisfaction when surveyed three years after their surgery. In conclusion, the use of the self-adhering sutureless mesh for inguinal hernia repair has been proving itself as effective as the traditional mesh. Adhesix™ is associated with low chronic pain rate, recurrence rate, and postoperative complications rate, and can be safely adopted as the sole technique for inguinal hernia repair.

Chronic pain following elective inguinal hernia repair—is it a common clinical problem?

2007 ◽  
Vol 32 (Suppl. 1) ◽  
pp. 174
Author(s):  
Z. M. Kirkor ◽  
T. N. Evans ◽  
H. Mathew ◽  
C. Swart ◽  
C. Morris ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Inguinal Hernia ◽  
Hernia Repair ◽  
Inguinal Hernia Repair ◽  
Clinical Problem ◽  
Common Clinical Problem

Assessment of Intra-Operative Difficulties and Early Post-Operative Complications in Laparoscopic Inguinal Hernia Repair using Conventional Polypropylene Mesh Versus 3D Mesh

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Hazem AbdelSalam Mohamed ◽  
Karim Fahmy ◽  
Mohammad Ahmad Abd-erRazik ◽  
Shaimaa Atef Ismaeil Awwad Elkomy
Keyword(s):  
Chronic Pain ◽  
Inguinal Hernia ◽  
Hernia Repair ◽  
Inguinal Hernia Repair ◽  
Three Dimensional ◽  
Laparoscopic Inguinal Hernia Repair ◽  
Fixation Time ◽  
3D Mesh ◽  
Laparoscopic Inguinal Hernia ◽  
Operative Complications

Abstract Background The fundamental mechanism of abdominal wall hernia formation is the loss of structural integrity at the musculotendinous layer. The exact cause of inguinal hernia is still unknown but the factors contributing in its occurrence include; preformed congenital sac, chronic passive rise in the intra-abdominal pressure and weak abdominal wall. Aim of the Work To assess intra-operative difficulties of laparoscopic inguinal hernia repair using two different meshes: The conventional polyproline mesh and the three-dimensional (3D) mesh, as regard the operative time. And early post-operative complications including post-operative seroma, early postoperative pain, chronic pain and limitation of function. Patients and Methods In our study 30 patients were recruited according to our preset inclusion and exclusion criteria. They were divided randomly into two groups, a group in which the 3D mesh was used and a group in which the polypropylene mesh was used. The study was conducted in Ain Shams University hospitals for 6 months, in which patients where followed up from 3 to 6 months and compared in terms of intraoperative time, post-operative pain after one week, restriction of physical activity, seroma formation and presence of chronic pain. Results In our study the mean application time (minutes) in 3D group was found to be 7.07 ± 2.66 while in PP group it was found to be 12.53±3.66 with highly statistically significant difference between them at p &lt; 0.001. We believe that this difference in fixation time in our present study is attributed to easy insertion through the port, easy intraoperative handling, and easy unfolding of 3D mesh. Conclusion The use of three-dimensional mesh (3D mesh) for laparoscopic inguinal hernia repair is a safe and viable option. It offers many advantages in terms of less fixation time, shorter hospital stays, early recovery with a better movement limitation score. Whereas chronic pain was found to be similar in both groups. Further, elimination of tacks for fixation and shorter hospital stay may reduce the cost of 3D mesh. Longer-term studies are recommended with a larger sample size and follow up duration for better assessment of chronic pain, also for following up on recurrence.

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