Factors Determining Outcome After Surgery for Chronic Groin Pain Following a Lichtenstein Hernia Repair

Zwaans, W A R; Verhagen, Tim; Roumen, R. M. H.; Scheltinga, Marc R.

doi:10.1007/s00268-015-3183-5

Cited by 23 publications

(15 citation statements)

References 56 publications

(75 reference statements)

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“…A new study used QST to distinguish between inflammatory and neuropathic pain and offered a pain operation (mesh removal) to patients with significant inflammatory pain; however, QST was not able to predict the outcome (27). The only study, so far, analyzing preoperative predictors suggested that female gender and opioid use were associated with poorer clinical outcome in 136 patients with chronic pain after Lichtenstein's hernia repair (28).…”

Section: Discussionmentioning

confidence: 99%

A Simplified clinical algorithm for standardized surgical treatment of chronic pain after inguinal hernia repair: A quality assessment study

et al. 2020

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Background: The optimal surgical strategy for the treatment of chronic pain after inguinal hernia repair is controversial and based on relatively weak evidence. The purpose of this study was to analyze pain-related functional impairment using a simplified clinical treatment algorithm for a standardized surgical treatment. The algorithm was predefined, and the indication to operate was based on strict criteria. Methods: This was a prospective, non-controlled, explorative study. The pain operation was either open triple neurectomy with total mesh removal or laparoscopic retroperitoneal triple neurectomy. A clinically relevant postoperative change was defined as ⩾25% change from the baseline level. Primary outcome was pain-related impairment of physical function using the Activity Assessment Scale. Secondary outcomes included Individual Patient-Reported Outcome Measures, Hospital Anxiety and Depression Scale, and PainDETECT Questionnaire. Results: A total of 240 patients were referred (2016–2019). Sixty-six patients were included for the analysis. A total of 25% of referred patients were offered a pain operation. Follow-up was a median 3 months (range: 3–13). Activity Assessment Scale scores were clinically relevant improved in 43 patients (68%), not clinically relevant different in 19 (30%), and clinically relevant worsened in one (2%). Secondary outcome scores were all significantly improved ( P < 0.05) except for the risk of postoperative depression ( P = 0.092). Fifty-one patients (77%) reported that chronic groin pain was reduced after the operation. Conclusion: Pain-related functional impairment was improved with clinical relevance in roughly 70% of patients through a simplified clinical algorithm for surgical treatment of severe chronic pain after an inguinal hernia repair.

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Section: Discussionmentioning

confidence: 99%

A Simplified clinical algorithm for standardized surgical treatment of chronic pain after inguinal hernia repair: A quality assessment study

et al. 2020

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“…In addition, studies on primary inguinal herniorrhaphy showed that spinal anaesthesia results in shorter hospital stay, less postoperative analgesic requirements, prolonged time to first analgesic requirement, equal operation room time and equal time-to-home readiness [22–24]. Only recently, a potential beneficial effect of spinal anaesthesia on surgery for groin pain was demonstrated [15]. This is the first randomised trial comparing two routine anaesthetic modalities for remedial surgery.…”

Section: Discussionmentioning

confidence: 99%

“…All remedial surgeries are performed using an open approach as previously published [15]. Patients are randomised to either spinal or general anaesthesia.…”

Section: Methodsmentioning

confidence: 99%

“…

Fig. 4Expected inclusion in the present trial, calculated by included patients in previously performed retrospective studies [15] …”

Section: Methodsmentioning

confidence: 99%

“…Experience with a spectrum of surgical procedures for inguinodynia is growing. One retrospective study in patients with inguinodynia suggested that spinal anaesthesia is associated with a superior outcome in terms of pain relief when compared to general anaesthesia [15]. A more robust trial is required to confirm these preliminary findings.…”

Section: Introductionmentioning

confidence: 99%

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Spinal versus general anaesthesia in surgery for inguinodynia (SPINASIA trial): study protocol for a randomised controlled trial

Zwaans

Mair

Scheltinga

et al. 2017

Trials

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BackgroundChronic inguinodynia (groin pain) is a common complication following open inguinal hernia repair or a Pfannenstiel incision but may also be experienced after other types of (groin) surgery. If conservative treatments are to no avail, tailored remedial surgery, including a neurectomy and/or a (partial) meshectomy, may be considered. Retrospective studies in patients with chronic inguinodynia suggested that spinal anaesthesia is superior compared to general anaesthesia in terms of pain relief following remedial operations. This randomised controlled trial is designed to study the effect of type of anaesthesia (spinal or general) on pain relief following remedial surgery for inguinodynia.MethodsA total of 190 adult patients who suffer from unacceptable chronic (more than 3 months) inguinodynia, as subjectively judged by the patients themselves, are included. Only patients scheduled to undergo a neurectomy and/or a meshectomy by an open approach are considered for inclusion and randomised to spinal or general anaesthesia. Patients are excluded if pain is attributable to abdominal causes or if any contraindications for either type of anaesthesia are present. Primary outcome is effect of type of anaesthesia on pain relief. Secondary outcomes include patient satisfaction, quality of life, use of analgesics and (in)direct medical costs. Patient follow-up period is one year.DiscussionThe first patient was included in January 2016. The expected trial deadline is December 2019. Potential effects are deemed related to the entire setting of type of anaesthesia. Since any setting is multifactorial, all of these factors may influence the outcome measures.This is the first large randomised controlled trial comparing the two most frequently used anaesthetic techniques in remedial surgery for groin pain. There is a definite need for evidence-based strategies to optimise results of these types of surgery. Besides pain relief, other important patient-related outcome measures are assessed to include patient’s perspectives on outcome.Trial registrationThe protocol (protocol number NL54115.015.15) is approved by the Medical Ethics Committee of Máxima Medical Centre, Veldhoven, The Netherlands. The study protocol was registered at www.trialregister.nl (NTR registration number: 5586) on 15 January 2016.Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-016-1746-x) contains supplementary material, which is available to authorized users.

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Surgical interventions for the management of chronic groin pain after hernia repair (postherniorrhaphy inguinodynia) in adults

Zwaans

Koning

Gurusamy

et al. 2017

Cochrane Database of Systematic Reviews

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Factors Determining Outcome After Surgery for Chronic Groin Pain Following a Lichtenstein Hernia Repair

Cited by 23 publications

References 56 publications

A Simplified clinical algorithm for standardized surgical treatment of chronic pain after inguinal hernia repair: A quality assessment study

A Simplified clinical algorithm for standardized surgical treatment of chronic pain after inguinal hernia repair: A quality assessment study

Spinal versus general anaesthesia in surgery for inguinodynia (SPINASIA trial): study protocol for a randomised controlled trial

Surgical interventions for the management of chronic groin pain after hernia repair (postherniorrhaphy inguinodynia) in adults

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