Comparative Study for Application of Polypropylene Monofilament Light Mesh, Polypropylene Monofilament Heavy Mesh and Self Gripping Polypropylene Mesh in Patients with Inguinal Hernia Surgically Treated with Lichtenstein Technique

Background / Objective. In our clinical study we have compared the results of intraoperative and postoperative period in patients with inguinal hernia treated operatively with Lichtenstein technique, where one of three different polypropylene meshes has been applied: polypropylene monofilament light mesh, polypropylene monofilament heavy mesh and self gripping polypropylene mesh. Follow up period have been one year. Methods. This study represents randomized, retrospective-prospective, comparative clinical study where 243 patients have been divided into three groups depends of prosthetic mesh that was applied with Lichtenstein technique. We have evaluated the connection between types of used mesh with some of followed parameters: postoperative pain intensity, postoperative patient mobilization, postoperative surgical site occurrences, duration of hospitalization, chronic pain, filling of foreign body in inguinal area and development of recurrences. Results. Patients with applied self gripping polypropylene mesh have significantly lowest pain, lowest hospital stay and lowest duration of surgical procedure than other two groups of patients. In term of chronic pain, only statistically significance we confirmed between the groups of heavy monofilament mesh and self griping polypropylene mesh, where higher number of patients from group with monofilament polypropylene light mesh reported chronic pain. In our study we confirmed that working status and patient age have significant influence on the intensity of postoperative pain in all three patients group. There is no statistical correlation between type of the mesh and surgical site occurrence rate. Conclusion. Patients with applied self gripping polypropylene mesh have significantly lowest pain, lowest hospital stay, lowest duration of surgical procedure and less number of patients experienced feeling of “foreign body” in their groin than other two groups of patients.

Download Full-text

COMPARATIVE STUDY OF POSTOPERATIVE PAIN BETWEEN THE LICHTENSTEIN AND LAPAROSCOPY SURGICAL TECHNIQUES FOR THE TREATMENT OF UNILATERAL PRIMARY INGUINAL HERNIA

ABCD Arquivos Brasileiros de Cirurgia Digestiva (São Paulo) ◽

10.1590/0102-6720201700030003 ◽

2017 ◽

Vol 30 (3) ◽

pp. 173-176 ◽

Cited By ~ 7

Author(s):

Leandro Mendonça PEDROSO ◽

Renato Miranda DE-MELO ◽

Nelson Jorge DA-SILVA-JR

Keyword(s):

Chronic Pain ◽

Inguinal Hernia ◽

Data Analysis ◽

Surgical Treatment ◽

Postoperative Pain ◽

Treatment Options ◽

Surgical Techniques ◽

Lichtenstein Technique ◽

Primary Inguinal Hernia ◽

Lichtenstein Procedure

ABSTRACT Background: There are several surgical treatment options for inguinal hernia; however, there is no consensus on the literature identifying which surgical technique promotes less postoperative pain. Aim: To compare the intensity of postoperative pain between the surgical techniques Lichtenstein and transabdominal pre-peritoneal laparoscopy for the treatment of unilateral primary inguinal hernia. Methods: Were included 60 patients, of which 30 were operated through the Lichtenstein technique and 30 patients through the transabdominal pre-peritoneal laparoscopy. The pain levels were evaluated through the analogue visual scale for 2, 10 and 30 days after the surgery. Additionally, the recurrence rate and the presence of chronic pain and paresthesia were evaluated 12 months after the surgery. Results: Overall, the data analysis showed significant differences on pain levels between the surgical techniques. There were no significant differences between the pain levels for day 2. However, for 10 and 30 days after the surgery, the pain levels were significantly lower for the patients operated through the transabdominal pre-peritoneal laparoscopy technique compared to the Lichtenstein technique. Furthermore, despite no recurrent hernias for both surgical techniques, 32 % of patients operated through the Lichtenstein technique reported chronic pain and paresthesia 12 months after the surgery, compared with 3,6% of patients operated through the transabdominal pre-peritoneal laparoscopy technique. Conclusion: There are differences between the surgical techniques, with the transabdominal pre-peritoneal laparoscopy procedure promoting significantly lower postoperative pain (10 and 30 days) and chronic pain (12 months) compared to the Lichtenstein procedure.

Download Full-text

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

The American Surgeon ◽

10.1177/000313481608200212 ◽

2016 ◽

Vol 82 (2) ◽

pp. 112-116 ◽

Cited By ~ 3

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.

Download Full-text

Is Postoperative Chronic Pain Syndrome Higher with Mesh Repair of Inguinal Hernia?

The American Surgeon ◽

10.1177/000313481007601021 ◽

2010 ◽

Vol 76 (10) ◽

pp. 1115-1118 ◽

Cited By ~ 4

Author(s):

Kristin Masukawa ◽

Samuel E. Wilson

Keyword(s):

Chronic Pain ◽

Inguinal Hernia ◽

Postoperative Pain ◽

Hernia Repair ◽

Inguinal Hernia Repair ◽

Mesh Repair ◽

Pain Syndrome ◽

Chronic Pain Syndrome ◽

Chronic Postoperative Pain ◽

Anatomic Repair

Chronic postoperative pain has been associated with mesh repair in meta-analysis of clinical trials. We compared the incidence of early complications, recurrence, and chronic pain syndrome in anatomic and mesh repairs in 200 patients. We defined chronic pain syndrome as pain in the inguinal area more than 3 months after inguinal hernia repair, patient referral to pain management, or necessity of a secondary procedure for pain control. The mean follow-up time was 4 years and 2 months for anatomic repair and 3 years and 7 months for mesh repair. The clinical outcomes did not reveal a significant disparity between the 100 consecutive patients who had mesh repair versus the 100 patients who had anatomic repair with regard to the incidence of superficial wound infection (0 vs 2%, P = 0.497), testicular swelling (12 vs 7%, P = 0.335), hematoma (1 vs 0%, P = 0.99), recurrence (3 vs 2%, P = 0.99), or chronic postoperative pain (4 vs 1%, P = 0.369). The anatomic procedure without mesh should continue to be offered to patients who have an initial inguinal hernia repair.

Download Full-text

Lower Incidence of Postoperative Pain after Open Inguinal Hernia Surgery with the Usage of Synthetic Glue-Coated Mesh (Adhesix®)

The American Surgeon ◽

10.1177/000313481808401240 ◽

2018 ◽

Vol 84 (12) ◽

pp. 1932-1937

Author(s):

Anna-Maria ThÖLix ◽

Jyrki Kössi ◽

Veikko Remes ◽

Tom Scheinin ◽

Jukka Harju

Keyword(s):

Chronic Pain ◽

Inguinal Hernia ◽

Postoperative Pain ◽

Demographic Data ◽

Mesh Fixation ◽

University Hospital ◽

Chronic Groin Pain ◽

Hernia Surgery ◽

Inguinal Hernia Surgery ◽

Anchoring System

Chronic groin pain after inguinal hernia mesh repair is a common problem. Mesh fixation without sutures has been suggested to have several advantages over the traditional suture fixation. The aim of this study was to compare two self-adhering meshes, the glued Adhesix® (AH) and the gripping Parietene ProGrip® (PP), and evaluate their impact on postoperative chronic pain and overall recovery. Two consultant surgeons performed altogether 393 open inguinal hernia operations at the Helsinki University Hospital during 2014 to 2015. The two groups, AH (n = 169) and PP (n = 224) were similar and comparable in terms of demographic data. The data were collected and analyzed from the patients’ medical records in the hospital's register. The patients were followed up for a period of 19 months (5-31 months). The number of patient contacts due to postoperative pain was significantly less common in the AH group than in the PP group, 4/169 (2.4%) versus 19/224 (8.5%) patients, respectively ( P = 0.011). The duration of pain was under three months for most patients, only two patients in the PP group had pain for over one year. The pain was treated most patients with anti-inflammatory painkillers, whereas injections of a local anesthetic and corticosteroid, and chronic pain medication was needed in some cases. It seems that the use of glue-coated mesh (Adhesix®) was associated with less postoperative visits due to pain compared with the self-fixating mesh with absorbable anchoring system (ProGrip®). Further studies with long-term follow-up are needed to confirm these results.

Download Full-text

Chronic Pain after Inguinal Hernia Repair

International Scholarly Research Notices ◽

10.1155/2014/839681 ◽

2014 ◽

Vol 2014 ◽

pp. 1-6 ◽

Cited By ~ 6

Author(s):

Mallikarjuna Manangi ◽

Santhosh Shivashankar ◽

Abhishek Vijayakumar

Keyword(s):

Chronic Pain ◽

Inguinal Hernia ◽

Postoperative Pain ◽

Hernia Repair ◽

Inguinal Hernia Repair ◽

Nerve Injury ◽

Statistical Significance ◽

Preemptive Analgesia ◽

Preoperative Pain ◽

Hernia Surgery

Background. Chronic postherniorrhaphy groin pain is defined as pain lasting >6 months after surgery, which is one of the most important complications occurring after inguinal hernia repair, which occurs with greater frequency than previously thought. Material and Methods. Patients undergoing elective inguinal hernioplasty in Victoria Hospital from November 2011 to May 2013 were included in the study. A total of 227 patients met the inclusion criteria and were available for followup at end of six months. Detailed preoperative, intraoperative, and postoperative details of cases were recorded according to proforma. The postoperative pain and pain at days two and seven and at end of six months were recorded on a VAS scale. Results. Chronic pain at six-month followup was present in 89 patients constituting 39.4% of all patients undergoing hernia repair. It was seen that 26.9% without preoperative pain developed chronic pain whereas 76.7% of patients with preoperative pain developed chronic pain. Preemptive analgesia failed to show statistical significance in development of chronic pain (P=0.079). Nerve injury was present in 22 of cases; it was found that nerve injury significantly affected development of chronic pain (P=0.001). On multivariate analysis, it was found that development of chronic pain following hernia surgery was dependent upon factors like preoperative pain, type of anesthesia, nerve injury, postoperative local infiltration, postoperative complication, and most importantly the early postoperative pain. Conclusions. In the present study, we found that chronic pain following inguinal hernia repair causes significant morbidity to patients and should not be ignored. Preemptive analgesia and operation under local anesthesia significantly affect pain. Intraoperative identification and preservation of all inguinal nerves are very important. Early diagnosis and management of chronic pain can remove suffering of the patient.

Download Full-text

Desarda versus Lichenstein technique for primary inguinal hernia treatment: one year results of a randomised clinical trial

International Surgery Journal ◽

10.18203/2349-2902.isj20202578 ◽

2020 ◽

Vol 7 (7) ◽

pp. 2147

Author(s):

Pinak Pani Dhar ◽

Upasana Mohanty ◽

Raman Kumar Shankar

Keyword(s):

Chronic Pain ◽

Inguinal Hernia ◽

Foreign Body ◽

Hernia Repair ◽

Inguinal Hernia Repair ◽

Operative Time ◽

Foreign Body Sensation ◽

Primary Inguinal Hernia ◽

Body Sensation

Background: The ideal operation to treat inguinal hernia is still far to define. The Shouldice method and other tissue-based techniques are still acknowledged to be acceptable for primary inguinal hernia repair according to European Hernia Society guidelines. Desarda’s technique, presented in 2001, is an original hernia repair method using an undetached strip of external oblique aponeurosis. This randomized trial compared outcomes after hernia repair with Desarda and mesh-based Lichtenstein techniques.Methods: A total of 42 participants (40 males and 2 females) were randomly assigned to the Desarda (group 1) and Lichtenstein (group 2), 19 vs 23 respectively. The primary outcomes measured were recurrence (for maximum follow up of 1 year and minimum of 5 months) and chronic pain. Additionally, operative time, early and late complications, foreign body sensation, and return to everyday activity were examined in hospital and at 7, 30 days, and 6, 12 months after surgery.Results: During the follow-up, one recurrence was observed in Desarda group after 10 months of surgery. Chronic pain was experienced by 10.5% and 8.7% of patients from groups Desarda and Lichtenstein respectively. Foreign body sensation and return to activity were comparable between the two groups. Operative time was less in Desarda group. There was significantly less seroma production in the Desarda group.Conclusions: The results of primary inguinal hernia repair with the Desarda and Lichtenstein techniques are comparable at the 1 year follow up. The technique may potentially increase the number of tissue-based methods available for treating groin hernias.

Download Full-text

Intra- and postoperative intravenous ketamine does not prevent chronic pain: A systematic review and meta-analysis

Scandinavian Journal of Pain ◽

10.1016/j.sjpain.2014.12.005 ◽

2015 ◽

Vol 7 (1) ◽

pp. 42-54 ◽

Cited By ~ 15

Author(s):

Elena Klatt ◽

Thomas Zumbrunn ◽

Oliver Bandschapp ◽

Thierry Girard ◽

Wilhelm Ruppen

Keyword(s):

Systematic Review ◽

Chronic Pain ◽

Postoperative Pain ◽

Regional Anaesthesia ◽

Meta Analysis ◽

Sufficient Evidence ◽

Chronic Postoperative Pain ◽

Postsurgical Pain ◽

Number Of Patients ◽

Pain At Rest

AbstractBackground and aims The development of postoperative chronic pain (POCP) after surgery is a major problem with a considerable socioeconomic impact. It is defined as pain lasting more than the usual healing, often more than 2–6 months. Recent systematic reviews and meta-analyses demonstrate that the N-methyl-D-aspartate-receptor antagonist ketamine given peri- and intraoperatively can reduce immediate postoperative pain, especially if severe postoperative pain is expected and regional anaesthesia techniques are impossible. However, the results concerning the role of ketamine in preventing chronic postoperative pain are conflicting. The aim of this study was to perform a systematic review and a pooled analysis to determine if peri- and intraoperative ketamine can reduce the incidence of chronic postoperative pain.Methods Electronic searches of PubMed, EMBASE and Cochrane including data until September 2013 were conducted. Subsequently, the titles and abstracts were read, and reference lists of reviews and retrieved studies were reviewed for additional studies. Where necessary, authors were contacted to obtain raw data for statistical analysis. Papers reporting on ketamine used in the intra- and postoperative setting with pain measured at least 4 weeks after surgery were identified. For meta-analysis of pain after 1, 3, 6 and 12 months, the results were summarised in a forest plot, indicating the number of patients with and without pain in the ketamine and the control groups. The cut-off value used for the VAS/NRS scales was 3 (range 0–10), which is a generally well-accepted value with clinical impact in view of quality of life.ResultsOur analysis identified ten papers for the comprehensive meta-analysis, including a total of 784 patients. Three papers, which included a total of 303 patients, reported a positive outcome concerning persistent postsurgical pain. In the analysis, only one of nine pooled estimates of postoperative pain at rest or in motion after 1, 3, 6 or 12 months, defined as a value ≥3 on a visual analogue scale of 0–10, indicated a marginally significant pain reduction.Conclusions Based on the currently available data, there is currently not sufficient evidence to support a reduction in chronic pain due to perioperative administration of ketamine. Only the analysis of postoperative pain at rest after 1 month resulted in a marginally significant reduction of chronic postoperative pain using ketamine in the perioperative setting.ImplicationsIt can be hypothesised, that regional anaesthesia in addition to the administration of perioperative ketamine might have a preventive effect on the development of persistent postsurgical pain. An additional high-quality pain relief intra- and postoperatively as well after discharge could be more effective than any particular analgesic method per se. It is an assumption that a low dose infusion ketamine has to be administered for more than 72 h to reduce the risk of chronic postoperative pain.

Download Full-text

Self-gripping Covidien™ ProGrip™ Mesh versus Polypropylene Mesh in Open Inguinal Hernia Repair: Multicenter Short Term Results

Prague Medical Report ◽

10.14712/23362936.2014.12 ◽

2013 ◽

Vol 114 (4) ◽

pp. 231-238 ◽

Cited By ~ 7

Author(s):

A. Yilmaz ◽

Oktay Yener ◽

B. Kaynak ◽

R. Yiğitbaşı ◽

M. Demir ◽

...

Keyword(s):

Inguinal Hernia ◽

Postoperative Pain ◽

Polypropylene Mesh ◽

Late Complication ◽

Routine Activity ◽

Daily Routine ◽

Lichtenstein Repair ◽

Open Inguinal Hernia Repair ◽

The Difference ◽

Surgery Duration

The purpose of this study was to compare clinical outcomes following sutureless ProGrip™ mesh repair to traditional Lichtenstein repair with polypropylene mesh secured with sutures. Data were collected prospectively and were analyzed for 57 male and 3 female patients with 60 inguinal hernias. All patients included underwent open surgical repair for inguinal hernia with polypropylene mesh or ProGrip mesh. In our two centres study sixty patients were operated; 30 were treated with Lichtenstein repair with polypropylene mesh (L group) and 30 with ProGrip mesh (P group) with or without fixation. The primary parameter measured was intensity of postoperative pain using visual analogue scale (VAS); other outcomes included assessment of early and late complication. VAS was assessed in 7 days and 4 months of the postoperative period. Our results show that VAS scored at the 7th postoperative day was 1.5 for the ProGrip mesh versus 4.4 in Lichtenstein repair group. The difference between groups was statistically significant (P=0.001). Surgery duration was significantly shorter in the P group (24.9 vs. 58.3 min; P=0.001). No recurrence was observed at 3 months in both groups. The 3-months follow-up has shown that time necessary to return to daily routine activity was significantly lower in the P group during the (P=0.001). Surgery duration, early and late postoperative, pain and return to daily routine activity rates were significantly reduced with self-gripping ProGrip mesh compared to Lichtenstein repair with polypropylene mesh.

Download Full-text

CHRONIC POSTOPERATIVE PAIN AFTER ANTERIOR INGUINAL HERNIA REPAIR

British Journal of Surgery ◽

10.1093/bjs/znab160.077 ◽

2021 ◽

Vol 108 (Supplement_3) ◽

Author(s):

A Arango Bravo ◽

V Sosa Rodríguez ◽

E Pérez Prudencio ◽

M Soto Dopazo ◽

C Nuño Iglesias ◽

...

Keyword(s):

Chronic Pain ◽

Inguinal Hernia ◽

Postoperative Pain ◽

Hernia Repair ◽

Inguinal Hernia Repair ◽

Fixation Method ◽

Inguinal Hernioplasty ◽

Chronic Postoperative Pain ◽

Bilateral Hernia ◽

The Third

Abstract INTRODUCTION Chronic postoperative pain after inguinal hernia repair is one of the most prevalent sequel after inguinal hernioplasty. MATERIAL AND METHODS A retrospective descriptive study was done, studying 414 patients who underwent programmed anterior inguinal hernioplasty in our centre between 01/01/18 and 12/31/19. Laterality, the type of mesh used and fixation method are studied, as well as the appearance of early postoperative pain, at one month and after the third month. P < 0.05 is considered a statistically significant value. RESULTS Of 414 patients, 90.6% were male, with a mean age of 65.5 years. In 89.1% the surgery was unilateral and 8.7% was hernia recurrence. 46.1% presented pre-surgical pain. 10.4% presented pain in the first check-up and 1.9% chronic pain. In 81.4%, flat mesh was placed, fixing it with suture in 83.6%. Greater pain was observed in the first review in patients operated on for bilateral hernia (22%, p 0.006). No differences were found regarding age, sex or recurrent hernias. In bilateral hernias, recurrent hernias and hernioplasty with plug, more postoperative complications were observed with a p < 0.05. In those patients who present complications, postoperative pain was observed in the first review in 16% (p < 0,05). CONCLUSIONS Patients who underwent bilateral hernioplasty present more complications and greater postoperative pain in the first revision, but not after the third postoperative month. No differences were observed in chronic pain in primary vs recurrent hernias. Post-surgical complications are related to greater initial postoperative pain but not to chronic pain.

Download Full-text

SNP in TNFα T308G is predictive for persistent postoperative pain following inguinal hernia surgery

Scandinavian Journal of Pain ◽

10.1016/j.sjpain.2012.05.040 ◽

2012 ◽

Vol 3 (3) ◽

pp. 188-188

Author(s):

Maija Kalliomäki ◽

Anne-Li Lind ◽

Alfhild Grönbladh ◽

Ulf Gunnarsson ◽

Gabriel Sandblom ◽

...

Keyword(s):

Chronic Pain ◽

Inguinal Hernia ◽

Postoperative Pain ◽

Significant Risk ◽

Taqman Assay ◽

Control Group ◽

Hernia Surgery ◽

Inguinal Hernia Surgery ◽

Increased Risk ◽

Persistent Postoperative Pain

Abstract Aim of investigation Persistent postoperative pain of some extent is seen in about 20% of patients after surgical operations, while 80% heal without chronic pain. The type of chronic pain that arises is mainly neuropathic, and is suggested to be in part regulated by genetic factors. In order to study the possible involvement of some candidate genes suggested to be involved in the processing of pain (BDNF, CACNA2D2, ORPM1, GRIK 3, GCH1 and TNF-α ), we performed a genetic association study in a well characterized clinical material of patients that had undergone surgery for inguinal hernia (n = 189). Of those 94 had developed a persistent postoperative pain state when investigated 2–3 years following the operation. The control group (n = 95) had undergone the same surgical procedure, and were pain free at follow up. Methods Genomic DNA was extracted from blood samples and genotyped by the Handy Bio-strand method and the TaqMan assay. Results The patients with persistent postoperative pain that had homozygous SNP in the TNF-α gene displayed increased risk of persistent postoperative pain with an odds risk of 2.42, compared the pain free controls. None of the other of the investigated genes were associated with significant risk of development of chronic pain following surgery. Conclusion The expression of TNF-α shows a significant impact on the risk of developing chronic pain after surgery. Further experimental and clinical studies are needed in order to fine map the TNF-α effect and to address underlying mechanisms.

Download Full-text