Abstract
Pain impairing daily activities following inguinal herniorrhaphy is reported by about 10% of patients, when asked 1–2 years postoperatively. However, the time course and consequences of postherniorrhaphy pain is not known in detail. A nationwide follow-up questionnaire study was undertaken 6.5 years postoperatively in 335 well-described patients reporting pain 1 year after inguinal herniorrhaphy in a previous questionnaire study. Three hundred and three patients, who were alive and could be contacted, received a questionnaire 6.5 years after the herniorrhaphy. Response rate was 88%. Of 267 patients responding, 57 were analyzed separately due to subsequent inguinal herniorrhaphy or other major surgery in the observation period, leaving 210 patients (69.3%) for primary analysis. Pain from the previous hernia site was reported by 72 patients (34.3%), and 52 patients (24.8%) reported that pain affected daily activities. Less pain, compared to the 1-year follow-up, was reported by 75.8%, while 16.7% had the same intensity level and 7.5% reported increased pain severity. In the subgroup of patients operated for a recurrence during the observation period and not included in primary analysis, 22 of 44 (50%) still experienced pain at 6.5 years, and 17 (38.6%) reported that pain affected daily activities (mean observation period 4.5 years). Pain after inguinal herniorrhaphy decreased from about 11% 1 year after surgery, but still affects daily activities in about 6% after 6.5 years. Patients operated for a recurrence are at higher risk for persistent pain.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Aasvang E, Kehlet H (2005) Chronic postoperative pain-the case of inguinal herniorrhaphy. Br J Anaesth 95:69–76
Poobalan AS, Bruce J, Smith WC, King PM, Krukowski ZH, Chambers WA (2003) A review of chronic pain after inguinal herniorrhaphy. Clin J Pain 19:48–54
Callesen T, Bech K, Nielsen R, Andersen J, Hesselfeldt P, Roikjaer O, Kehlet H (1998) Pain after groin hernia repair. Br J Surg 85:1412–1414
Callesen T, Bech K, Kehlet H (1999) Prospective study of chronic pain after groin hernia repair. Br J Surg 86:1528–1531
Poobalan AS, Bruce J, King PM, Chambers WA, Krukowski ZH, Smith WC (2001) Chronic pain and quality of life following open inguinal hernia repair. Br J Surg 88:1122–1126
Hair A, Duffy K, McLean J, Taylor S, Smith H, Walker A, MacIntyre IM, O’Dwyer PJ (2000) Groin hernia repair in Scotland. Br J Surg 87:1722–1726
Bay-Nielsen M, Perkins FM, Kehlet H (2001) Pain and functional impairment 1 year after inguinal herniorrhaphy: a nationwide questionnaire study. Ann Surg 233:1–7
The MRC Laparoscopic Groin Hernia Trial Group (1999) Laparoscopic versus open repair of groin hernia: a randomised comparison. The MRC Laparoscopic Groin Hernia Trial Group. Lancet 354:185–190
Grant AM, Scott NW, O’Dwyer PJ (2004) Five-year follow-up of a randomized trial to assess pain and numbness after laparoscopic or open repair of groin hernia. Br J Surg 91:1570–1574
Bay-Nielsen M, Kehlet H, Steering commitee of the Danish Hernia Database (1999) Establishment of a national Danish Hernia Database: preliminary report. Hernia 3:81–83
Cunningham J, Temple WJ, Mitchell P, Nixon JA, Preshaw RM, Hagen NA (1996) Cooperative hernia study. Pain in the postrepair patient. Ann Surg 224:598–602
Neumayer L, Giobbie-Hurder A, Jonasson O, Fitzgibbons R Jr, Dunlop D, Gibbs J, Reda D, Henderson W (2004) Open mesh versus laparoscopic mesh repair of inguinal hernia. N Engl J Med 350:1819–1827
Tschudi JF, Wagner M, Klaiber C, Brugger JJ, Frei E, Krahenbuhl L, Inderbitzi R, Boinski J, Hsu Schmitz SF, Husler J (2001) Randomized controlled trial of laparoscopic transabdominal preperitoneal hernioplasty vs shouldice repair. Surg Endosc 15:1263–1266
Wright D, Paterson C, Scott N, Hair A, O’Dwyer PJ (2002) Five-year follow-up of patients undergoing laparoscopic or open groin hernia repair: a randomized controlled trial. Ann Surg 235:333–337
Leibl BJ, Daubler P, Schmedt CG, Kraft K, Bittner R (2000) Long-term results of a randomized clinical trial between laparoscopic hernioplasty and shouldice repair. Br J Surg 87:780–783
Sondenaa K, Nesvik I, Breivik K, Korner H (2001) Long-term follow-up of 1059 consecutive primary and recurrent inguinal hernias in a teaching hospital. Eur J Surg 167:125–129
Heikkinen T, Bringman S, Ohtonen P, Kunelius P, Haukipuro K, Hulkko A (2004) Five-year outcome of laparoscopic and Lichtenstein hernioplasties. Surg Endosc 18:518–522
Bay-Nielsen M, Nilsson E, Nordin P, Kehlet H (2004) Chronic pain after open mesh and sutured repair of indirect hernia in young males. Br J Surg 91:1372–1376
Gillion JF, Faignez PL (1999) Chronic pain and cutaneous sensory changes after inguinal hernia repair: comparison between open and laparoscopic techniques. Hernia 3:75–80
Courtney CA, Duffy K, Serpell MG, O’Dwyer PJ (2002) Outcome of patients with severe chronic pain following repair of groin hernia. Br J Surg 89:1310–1314
Haapaniemi S, Nilsson E (2002) Recurrence and pain three years after groin hernia repair. Validation of postal questionnaire and selective physical examination as a method of follow-up. Eur J Surg 168:22–28
Liem MS, van Duyn EB, van der GY, van Vroonhoven TJ (2003) Recurrences after conventional anterior and laparoscopic inguinal hernia repair: a randomized comparison. Ann Surg 237:136–141
Aasvang E, Kehlet H (2005) Surgical management of chronic pain after inguinal hernia repair. Br J Surg 92:795–801
Acknowledgment
This study was supported by a grant from The Lundbeck Foundation.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Aasvang, E.K., Bay-Nielsen, M. & Kehlet, H. Pain and functional impairment 6 years after inguinal herniorrhaphy. Hernia 10, 316–321 (2006). https://doi.org/10.1007/s10029-006-0098-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10029-006-0098-y