Chronic pain after total extraperitoneal inguinal hernia repair occurs infrequently in patients, and findings from a study suggest that the means of mesh fixation, permanent or nonpermanant, is not linked to greater risk of this outcome.
Dr. Nihad Gutlic and colleagues from the Skåne University Hospital at University of Lund, Sweden, sought to compare total extraperitoneal inguinal hernia repair (TEP) done with permanent fixture (PF) of mesh vs. nonfixed (NF) or nonpermanent fixation (NPF) and the impact of the means of mesh fixation on chronic pain. Their results were published online in the July issue of Annals of Surgery.
Polypropylene surgical meshWikiMedia Commons/Zhangzhugang/Creative Commons
Prospective data were obtained from the Swedish Hernia Registry (SHR) and participants completed the Inguinal Pain Questionnaire (IPQ) and the Short Form-36 (SF-36) to measure health-related quality of life to assess chronic pain. Chronic pain was defined as pain that persisted more than 3 months after surgery.
The study included men aged 30-75 years, consecutively registered in the SHR for TEP repair of a primary groin hernia during January 2005 and May 2009, and the questionnaire was send between February 2010 and May 2010. A minimum follow-up of 6 months was stipulated. The IPQ assessed pain with 19 questions regarding the pain modalities intensity, frequency, duration, influence on daily activities, and testicular pain. Questions concerned “pain right now” and “pain past week” respectively, and answers were given on a 7-grade scale from “no pain” to “pain that could not be ignored – prompt medical advice sought.” Patients were followed for up to 33 months.
A total of 1,110 respondents were analyzed: 325 patients in the PF group and 785 patients in the NPF group (281 with fibrin glue and 504 NF). The PF group had more medial hernias (P < .003) and larger defect sizes (P < .002). There were no differences in the rate of reoperation between the two groups (P < .735).
For the IPQ questionnaire, 7.7% (n = 85) of patients reported having “pain that could not be ignored” in the last week with no difference between the PF group and the NF/NPF groups (P < .462). Of those patients responding, 5.4% reported having “pain right now” (n = 59) with no difference between the two groups (P < .270).
The authors conclude, “that TEP, carried out on men for primary inguinal hernia, is associated with a low frequency of chronic postoperative pain. No difference was seen between permanent and nonpermanent fixation regarding chronic pain.”
The authors declared no conflicts of interest. The study was supported by the Lund (Sweden) University, Region Skåne Research and Development Funds, and the Bard Norden AB and Helge B. Wulffs Foundation.