Assessment of the incidence of chronic pain and discomfort after primary inguinal hernia repair

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• 作者：Hideyuki Takata ; MD ; Takeshi Matsutani ; MD ; ^{matsutani@nms.ac.jp" class="auth_mail" title="E-mail the corresponding author} ; Nobutoshi Hagiwara ; MD ; Junji Ueda ; MD ; Hiroki Arai ; MD ; Yasuyuki Yokoyama ; MD ; Tsutomu Nomura ; MD ; Eiji Uchida ; MD
• 关键词：Inguinal hernia ; Chronic pain ; Discomfort ; Hernia repair ; Transabdominal preperitoneal repair
• 刊名：Journal of Surgical Research
• 出版年：2016
• 出版时间：December 2016
• 年：2016
• 卷：206
• 期：2
• 页码：391-397
• 全文大小：443 K

文摘

Chronic pain and discomfort is a notable complication after inguinal hernia repair. This study assesses the incidence and degree of chronic pain and discomfort after primary inguinal hernia repair performed in our hospital and aims to clarify its relationship to the type of mesh placement.

Materials and methods

A retrospective analysis was conducted of 334 patients (378 lesions) who underwent primary inguinal hernia using the Lichtenstein (onlay mesh), Ultrapro Plug (UPP; onlay plus plug mesh), modified Kugel Patch (onlay and underlay mesh), or laparoscopic transabdominal preperitoneal (TAPP; underlay mesh) procedure. Postoperative pain was assessed using a numerical rating scale at postoperative 2-3 wk, 3 mo, and 6 mo. Postoperative discomfort was assessed 6 mo afterward.

Results

Questionnaire responses were received for 378 lesions (100%) after 2-3 wk, 229 (60.6%) after 3 mo, and 249 (65.9%) after 6 mo. The majority of chronic pain experienced was mild, and no patient suffered from severe pain. The level of pain tended to be less for the TAPP procedure than for other methods. Discomfort at rest was significantly less for TAPP versus Ultrapro Plug (P < 0.01), and discomfort with movement was significantly less for TAPP versus modified Kugel (P < 0.05).

Conclusions

Onlay mesh appears to be a risk factor in chronic pain and discomfort. The lower level of chronic pain and discomfort with underlay mesh placement is considered to result from the reduced risk of nerve damage in this procedure than in the onlay mesh placement procedure.