Surgical Technique and Chronic Postoperative Inguinal Pain in Patients Undergoing Open Inguinal Hernioplasty in Portugal: A Prospective Multicentric Cohort Study

Authors

  • Irène Santos Faculdade de Medicina. Universidade do Porto. Porto. .
  • Joana F. F. Simões Hospital Garcia de Orta. Unidade Local de Saúde de Almada-Seixal. Almada.
  • Cláudia Camila Dias Faculdade de Medicina. Universidade do Porto. Porto.
  • Mafalda Sampaio Alves Faculdade de Medicina. Universidade do Porto. Porto.
  • José Azevedo Fundação Champalimaud. Lisboa.
  • Miguel Cunha Unidade Local de Saúde do Algarve. Portimão.
  • Ana Alagoa João Fundação Champalimaud. Lisboa.
  • José Guilherme Nobre Hospital Garcia de Orta. Unidade Local de Saúde de Almada-Seixal. Almada.
  • Maria Picciochi Hospital Professor Doutor Fernando Fonseca. Unidade Local de Saúde de Amadora/Sintra. Amadora.
  • António Sampaio Soares Hospital Professor Doutor Fernando Fonseca. Unidade Local de Saúde de Amadora/Sintra. Amadora.
  • Bárbara Vieira Hospital de Santo Espírito da Ilha Terceira. Ilha Terceira.
  • Mariana Peyroteo Instituto Português de Oncologia do Porto Francisco Gentil. Porto.
  • on behalf of PT Surg

DOI:

https://doi.org/10.20344/amp.20277

Keywords:

Chronic Pain/etiology, Hernia, Inguinal/surgery, Herniorrhaphy/methods, Pain, Postoperative, Portugal

Abstract

Introduction: Evidence about the advantage of Lichtenstein’s repair, the guidelines’ recommended technique, is scarce regarding postoperative chronic inguinal pain (CPIP). The primary aim of this study was to compare CPIP in patients undergoing Lichtenstein versus other techniques.
Methods: Prospective multicentric cohort study including consecutive adults undergoing elective inguinal hernia repair in Portuguese hospitals (October - December 2019). Laparoscopic and mesh-free hernia repairs were excluded. The primary outcome was postoperative pain at three months, defined as a score of ≥ 3/10 in the European Hernia Society Quality of Life score pain domain. The secondary outcome was 30-day postoperative complications.
Results: Eight hundred and sixty-nine patients from 33 hospitals were included. Most were men (90.4%) and had unilateral hernias (88.6%). Overall, 53.6% (466/869) underwent Lichtenstein’s repair, and 46.4% (403/869) were treated with other techniques, of which 83.9% (338/403) were plug and patch. The overall rate of CPIP was 16.6% and 12.2% of patients had surgical complications. The unadjusted risk was similar for CPIP (OR 0.76, p = 0.166, CI 0.51 - 1.12) and postoperative complications (OR 1.06, p = 0.801, CI 0.69 - 1.60) between Lichtenstein and other techniques. After adjustment, the risk was also similar for CPIP (OR 0.83, p = 0.455, CI 0.51 - 1.34) and postoperative complications (OR 1.14, p = 0.584, CI 0.71 - 1.84).
Conclusion: The Lichtenstein technique was not associated with lower CPIP and showed comparable surgical complications. Further investigation as- sessing long term outcomes is necessary to fully assess the benefits of the Lichtenstein technique regarding CPIP.

Downloads

Download data is not yet available.

References

Kingsnorth A, LeBlanc K. Hernias: inguinal and incisional. Lancet. 2003;362:1561-71.

Fitzgibbons RJ Jr., Ramanan B, Arya S, Turner SA, Li X, Gibbs JO, et al. Long-term results of a randomized controlled trial of a nonoperative strategy (watchful waiting) for men with minimally symptomatic inguinal hernias. Ann Surg. 2013;258:508-15.

Hair A, Paterson C, Wright D, Baxter JN, O’Dwyer PJ. What effect does the duration of an inguinal hernia have on patient symptoms? J Am Coll Surg. 2001;193:125-9.

Nakagawa M, Nagase T, Akatsu T, Imai S, Fujimura N, Asagoe T, et al. Randomized prospective trial comparing clinical outcomes 3 years after surgery by marcy repair and prolene hernia system repair for adult indirect inguinal hernia. Surg Today. 2013;43:1109-15.

Sorensen LT, Friis E, Jorgensen T, Vennits B, Andersen BR, Rasmussen GI, et al. Smoking is a risk factor for recurrence of groin hernia. World J Surg. 2002;26:397-400.

PT Surg. Predictors of low quality of life after open inguinal hernia repair using the EuraHS-QoL score: prospective multicentric cohort study across 33 hospitals. Hernia. 2022;26:225-32.

Bay-Nielsen M, Nilsson E, Nordin P, Kehlet H, Swedish Hernia Data Base the Danish Hernia Data Base. Chronic pain after open mesh and sutured repair of indirect inguinal hernia in young males. Br J Surg. 2004;91:1372-6.

Szopinski J, Dabrowiecki S, Pierscinski S, Jackowski M, Jaworski M, Szuflet Z. Desarda versus Lichtenstein technique for primary inguinal hernia treatment: 3-year results of a randomized clinical trial. World J Surg. 2012;36:984-92.

Bay-Nielsen M, Thomsen H, Andersen FH, Bendix JH, Sorensen OK, Skovgaard N, et al. Convalescence after inguinal herniorrhaphy. Br J Surg. 2004;91:362-7.

Arvidsson D, Berndsen FH, Larsson LG, Leijonmarck CE, Rimbäck G, Rudberg C, et al. Randomized clinical trial comparing 5-year recurrence rate after laparoscopic versus Shouldice repair of primary inguinal hernia. Br J Surg. 2005;92:1085-91.

Bisgaard T, Bay-Nielsen M, Kehlet H. Re-recurrence after operation for recurrent inguinal hernia. A nationwide 8-year follow-up study on the role of type of repair. Ann Surg. 2008;247:707-11.

Malik A, Bell CM, Stukel TA, Urbach DR. Recurrence of inguinal hernias repaired in a large hernia surgical specialty hospital and general hospitals in Ontario, Canada. Can J Surg. 2016;59:19-25.

HerniaSurge Group. International guidelines for groin hernia management. Hernia. 2018;22:1-165.

O’Dwyer PJ, Norrie J, Alani A, Walker A, Duffy F, Horgan P. Observation or operation for patients with an asymptomatic inguinal hernia: a randomized clinical trial. Ann Surg. 2006;244:167-73.

Lichtenstein IL, Shulman AG, Amid PK, Montllor MM. The tension-free hernioplasty. Am J Surg. 1990;160:139-41.

Simons MP, Aufenacker T, Bay-Nielsen M, Bouillot JL, Campanelli G, Conze J, et al. European Hernia Society guidelines on the treatment of inguinal hernia in adult patients. Hernia. 2009;13:343-403.

Miserez M, Peeters E, Aufenacker T, Bouillot JL, Campanelli G, Conze J, et al. Update with level 1 studies of the European Hernia Society guidelines on the treatment of inguinal hernia in adult patients. Hernia. 2014;18:151-63.

Yu M, Xie WX, Li S, Wang DC, Huang LY. Meta-analysis of mesh-plug repair and Lichtenstein repair in the treatment of primary inguinal hernia. Updates Surg. 2021;73:1297-306.

Zhao G, Gao P, Ma B, Tian J, Yang K. Open mesh techniques for inguinal hernia repair: a meta-analysis of randomized controlled trials. Ann Surg. 2009;250:35-42.

Decker E, Currie A, Baig MK. Prolene hernia system versus Lichtenstein repair for inguinal hernia: a meta-analysis. Hernia. 2019;23:541-6.

Willaert W, Bacquer DD, Rogiers X, Troisi R, Berrevoet F. Open preperitoneal techniques versus Lichtenstein repair for elective inguinal hernias. Cochrane Database Syst Rev. 2012;2012;7:CD008034.

Sajid MS, Craciunas L, Singh KK, Sains P, Baig MK. Open transinguinal preperitoneal mesh repair of inguinal hernia: a targeted systematic review and meta-analysis of published randomized controlled trials. Gastroenterol Rep. 2013;1:127-37.

Koning GG, Keus F, Koeslag L, Cheung CL, Avci M, Van Laarhoven CJ, et al. Randomized clinical trial of chronic pain after the transinguinal preperitoneal technique compared with Lichtenstein’s method for inguinal hernia repair. Br J Surg. 2012;99:1365-73.

PT Surg. Portuguese Inguinal Hernia Cohort (PINE) study. medRxiv. 2020:2020.12.19.20247585.

Alhambra-Rodriguez de Guzman C, Picazo-Yeste J, Tenias-Burillo JM, Moreno-Sanz C. Improved outcomes of incarcerated femoral hernia: a multivariate analysis of predictive factors of bowel ischemia and potential impact on postoperative complications. Am J Surg. 2013;205:188-93.

Pesic I, Karanikolic A, Djordjevic N, Stojanovic M, Stanojevic G, Radojkvic M, et al. Incarcerated inguinal hernias surgical treatment specifics in elderly patients. Vojnosanit Pregl. 2012;69:778-82.

Primatesta P, Goldacre MJ. Inguinal hernia repair: incidence of elective and emergency surgery, readmission and mortality. Int J Epidemiol. 1996;25:835-9.

Kjaergaard J, Bay-Nielsen M, Kehlet H. Mortality following emergency groin hernia surgery in Denmark. Hernia. 2010;14:351-5.

Ge BJ, Huang Q, Liu LM, Bian HP, Fan YZ. Risk factors for bowel resection and outcome in patients with incarcerated groin hernias. Hernia. 2010;14:259-64.

Azari Y, Perry Z, Kirshtein B. Strangulated groin hernia in octogenarians. Hernia. 2015;19:443-7.

Bay-Nielsen M, Kehlet H, Strand L, Malmstrom J, Andersen FH, Wara P, et al. Quality assessment of 26,304 herniorrhaphies in Denmark: a prospective nationwide study. Lancet. 2001;358:1124-8.

Junge K, Rosch R, Klinge U, Schwab R, Peiper Ch, Binnebosel M, et al. Risk factors related to recurrence in inguinal hernia repair: a retrospective analysis. Hernia. 2006;10:309-15.

Amato B, Moja L, Panico S, Persico G, Rispoli C, Rocco N, et al. Shouldice technique versus other open techniques for inguinal hernia repair. Cochrane Database Syst Rev. 2012;4:CD001543.

Eklund A, Montgomery A, Bergkvist L, Rudberg C; Swedish Multicentre Trial of Inguinal Hernia Repair by Laparoscopy (SMIL) Study Group. Chronic pain 5 years after randomized comparison of laparoscopic and Lichtenstein inguinal hernia repair. Br J Surg. 2010;97:600-8.

Köninger J, Redecke J, Butters M. Chronic pain after hernia repair: a randomized trial comparing Shouldice, Lichtenstein and TAPP. Langenbecks Arch Surg. 2004;389:361-5.

Schmedt CG, Sauerland S, Bittner R. Comparison of endoscopic procedures vs Lichtenstein and other open mesh techniques for inguinal hernia repair: a meta-analysis of randomized controlled trials. Surg Endosc. 2005;19:188-99.

Lau H, Patil NG, Yuen WK. Day-case endoscopic totally extraperitoneal inguinal hernioplasty versus open Lichtenstein hernioplasty for unilateral primary inguinal hernia in males. Surg Endosc. 2006;20:76-81.

Eklund A, Rudberg C, Smedberg S, Enander LK, Leijonmarck CE, Österberg J, et al. Short-term results of a randomized clinical trial comparing Lichtenstein open repair with totally extraperitoneal laparoscopic inguinal hernia repair. Br J Surg. 2006;93:1060-8.

Dahlstrand U, Sandblom G, Ljungdahl M, Wollert S, Gunnarsson U. TEP under general anesthesia is superior to Lichtenstein under local anesthesia in terms of pain 6 weeks after surgery: results from a randomized clinical trial. Surgical Endosc. 2013;27:3632-8.

Neto AJ, Magalhães C, Domingues S, Seca MJ. Abdominal wall hernias. organize to improve. Rev Port Cir. 2010;15:15-21.

Downloads

Published

2024-07-01

How to Cite

1.
Santos I, F. F. Simões J, Dias CC, Sampaio Alves M, Azevedo J, Cunha M, Alagoa João A, Nobre JG, Picciochi M, Sampaio Soares A, Vieira B, Peyroteo M, on behalf of PT Surg. Surgical Technique and Chronic Postoperative Inguinal Pain in Patients Undergoing Open Inguinal Hernioplasty in Portugal: A Prospective Multicentric Cohort Study. Acta Med Port [Internet]. 2024 Jul. 1 [cited 2024 Jul. 3];37(7-8):507-1. Available from: https://actamedicaportuguesa.com/revista/index.php/amp/article/view/20277

Issue

Vol. 37 No. 7-8 (2024): July-August

Section

Original

License

Copyright (c) 2024 Acta Médica Portuguesa

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

All the articles published in the AMP are open access and comply with the requirements of funding agencies or academic institutions. The AMP is governed by the terms of the Creative Commons ‘Attribution – Non-Commercial Use - (CC-BY-NC)’ license, regarding the use by third parties.

It is the author’s responsibility to obtain approval for the reproduction of figures, tables, etc. from other publications.

Upon acceptance of an article for publication, the authors will be asked to complete the ICMJE “Copyright Liability and Copyright Sharing Statement “(http://www.actamedicaportuguesa.com/info/AMP-NormasPublicacao.pdf) and the “Declaration of Potential Conflicts of Interest” (http:// www.icmje.org/conflicts-of-interest). An e-mail will be sent to the corresponding author to acknowledge receipt of the manuscript.

After publication, the authors are authorised to make their articles available in repositories of their institutions of origin, as long as they always mention where they were published and according to the Creative Commons license.

Crossref
Scopus
Google Scholar
Europe PMC