O17 CHRONIC GROIN PAIN DUE TO OR DESPITE THE HERNIA REPAIR

Aim There is a discrepancy between the high frequency of chronic post-operative pain reported in questionnaire-based studies after groin hernia surgery and the clinical experience of many surgeons in which it is infrequent that patients return after surgery because of chronic post-operative pain. This is supported by the Swedish Hernia Registry, where the proportion of patients who are re-operated for chronic post-operative pain is 0.02-0.03% for open methods and less than 0,01% for laparo-endoscopic methods. The aim of this study is to find the incidence of non-surgical causes of chronic groin pain and other patient-reported outcomes after inguinal hernia surgery. Material and Methods Prospective cohort observation study of patients evaluated for suspected inguinal hernia-related symptoms at a hernia clinic in Sweden during 1 year. Patients completed validated pain forms before surgery and 6 and 12 months after surgery. Patients were assessed preoperatively about the possible causes of groin pain according to a checklist. For this purpose, a questionnaire of inguinal hernia-related symptoms was used. Patients with moderate or severe chronic groin pain after surgery were offered to participate in a clinical examination where the pain was evaluated for probable cause according to a checklist. Results 574 patients were included in the study, of which 372 were operated on and answered the post-operative questionnaires. Preliminary results on surgical and non-surgical causes of chronic groin pain after hernioplasty and other patient-reported outcomes will be presented at Hernia 2021 EHS-AHS Joint Congress. Conclusions Proportion of patients with chronic groin pain related to groin hernia surgery and other non-surgical pathologies will be reported.

Headache, seizures and loss of consciousness in an elderly male following groin hernia surgery

Headache after lumbar puncture is a common occurrence and have a benign course in the majority. In rare cases, it can be a mani­festation of rare but potentially life-threatening intracranial complications. We discuss a case of 65 years male patient who was operated for left inguinal hernia under spinal anaesthesia, had persistent headache partial response to conservative measures developed one episode of seizures and lapsed into altered sensorium. Imaging findings were suggestive of extensive left frontal-temporoparietal acute SDH with mass effect and midline shift. The hematoma was evacuated and the patient recovered well. Prolonged and persistent post-dural puncture headache complicated by atypical neurological deterioration following spinal anaesthesia should prompt the physician to consider the possibility of intracranial complications and to seek immediate radiological investigations.

Groin Hernia Surgery in Uganda: Caseloads and Practices at Hospitals Operating Within the Publicly Funded Healthcare Sector

Background Groin hernia is a major public health problem with over 200 million people affected. The unmet need for surgery is greatest in Sub-Saharan Africa where specialist surgeons are few. This study was carried out in Uganda to investigate caseloads and practices of groin hernia surgery at publicly funded hospitals. Methods The study employed mixed methods covering 29 hospitals: the National Referral Hospital (NRH), 14 Regional Referral Hospitals (RRH) and 14 General Hospitals (GH). In part one of the study, surgeons and medical doctors performing hernia repair were interviewed about their practices and experiences of groin hernia surgery. In part two, operating theater records from 2013 to 2014 from the participating hospitals were reviewed and information about groin hernia operations collected. Results All respondents reported that sutured repair was the first-choice method. A total of 5518 groin hernia repairs were performed at the participating hospitals, i.e., an annual hernia repair rate of 7/100 000 population. Of the patients operated, almost 16% were women and 24% were children. Local anesthesia (LA) was used in 40% of the cases, and non-surgeon physicians performed 70.3% of the groin hernia repairs. Conclusion Groin hernia repair outputs need to increase along with the training of surgical providers in modern hernia repair methods. Methods and outcomes for hernia repair in women and children should be investigated to improve the quality of care.