Groin Pain After Inguinal Hernia Repair

Nguyen, David K.; Amid, Parviz K.; Chen, David C.

doi:10.1016/j.yasu.2016.04.003

Cited by 50 publications

(17 citation statements)

References 68 publications

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“…In the United States (US), an estimated 4.5 million people are impacted by groin hernia, and each year approximately 800,000 people are treated for groin hernia [ 1 , 2 ]. Chronic postoperative groin pain (CPGP) is an infrequent but notable complication associated with inguinal hernia repair (IHR) [ 3 ]. Two important risk factors for CPGP are preoperative groin pain and acute postoperative groin pain (APGP) [ 4 , 5 ].…”

Section: Introductionmentioning

confidence: 99%

Patient perceptions of acute pain and activity disruption following inguinal hernia repair: a propensity-matched comparison of robotic-assisted, laparoscopic, and open approaches

Bittner

Cesnik

Kirwan³

et al. 2018

J Robotic Surg

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Few publications describe the potential benefit of robotic-assisted inguinal hernia repair on acute postoperative groin pain (APGP). This study compared patients’ perceptions of APGP, activity limitation, and overall satisfaction after robotic-assisted- (R), laparoscopic (L), or open (O) inguinal hernia repair (IHR). Random samples of patients from two web-based research panels and surgical practices were screened for patients who underwent IHR between October 28, 2015 and November 1, 2016. Qualified patients were surveyed to assess perceived APGP at 1 week postoperatively, activity disruption, and overall satisfaction. Three cohorts based on operative approach were compared after propensity matching. Propensity scoring resulted in 83 R-IHR matched to 83 L-IHR respondents, while 85 R-IHR matched with 85 O-IHR respondents. R-IHR respondents recalled less APGP compared to respondents who had O-IHR (4.1 ± 0.3 vs 5.6 ± 0.3, p < 0.01) but similar APGP compared to L-IHR (4.0 ± 0.3 vs 4.4 ± 0.3, p = 0.37). Respondents recalled less activity disruption 1 week postoperatively after R-IHR versus O-IHR (6.1 ± 0.3 vs. 7.3 ± 0.2, p < 0.01) but similar levels of activity disruption after R-IHR and L-IHR (6.0 ± 0.3 vs. 6.6 ± 0.27, p = 0.32). At the time of the survey, respondents perceived less physical activity disruption after R-IHR compared to O-IHR (1.4 ± 0.2 vs. 2.8 ± 0.4, p < 0.01) but similar between R-IHR and L-IHR (1.3 ± 0.2 vs 1.2 ± 0.2, p = 0.94). Most respondents felt satisfied with their outcome regardless of operative approach. Patient perceptions of pain and activity disruption differ by approach, suggesting a potential advantage of a minimally invasive technique over open for IHR. Further studies are warranted to determine long-term outcomes regarding pain and quality of life after IHR.

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Section: Introductionmentioning

confidence: 99%

Patient perceptions of acute pain and activity disruption following inguinal hernia repair: a propensity-matched comparison of robotic-assisted, laparoscopic, and open approaches

Bittner

Cesnik

Kirwan³

et al. 2018

J Robotic Surg

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“…It is well studied in adults and algorithms were prepared. 4,5 Mesh is not used in routine indirect inguinal hernia repair in children.…”

Section: Discussionmentioning

confidence: 99%

Telephone survey of inguinal hernia repair patients older than 5 years for chronic pain

2018

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Background: Little is known about chronic pain in the inguinal region following inguinal hernia repair in children. A study was conducted to examine whether pain is an important complication of inguinal hernia surgery in children.Methods: A telephone survey was performed of former patients who had undergone inguinal hernia repair and are now older than 5 years. A questionnaire was prepared and the questions were asked by paediatric surgeons.Results: There were 66 former patients now older than 5 years old. Patients had inguinal hernia repair at between 11 days and 14 years of age (mean 3.24 years). Age during telephone survey was between 5 and 18 years (mean 7.48 years). One patient had late pain related to direct inguinal hernia occurrence (1.5%). Three patients described non-specific abdominal pain unrelated to the inguinal operation. None of the patients were taking painkillers.Conclusions: Although this is a small sample group, chronic pain does not seem to be a serious problem after inguinal hernia repair in children.

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“…Recently, a histopathological study in explanted meshes demonstrated neo-innervation by nerve fibers and a significantly higher nerve fiber density in specimens obtained due to re-surgery for groin hernia repair related persistent pain than for non-pain hernia recurrence [23]. Furthermore, the reactive fibrosis may impinge upon or compress the spermatic cord leading to movement-related pain and dysejaculation [24]. Second, short-lasting, nonspecific, anticipated advantageous, placebo, or Hawthorne effects may occur in surgical procedures, called the "honeymoon period".…”

Section: Pain Trajectories: Potential Pathophysiological Mechanismsmentioning

confidence: 99%

Trajectories in severe persistent pain after groin hernia repair: a retrospective analysis

Jensen

Bäckryd

Hilden

et al. 2020

Scandinavian Journal of Pain

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ObjectivesSevere persistent post-surgical pain (PPSP) remains a significant healthcare problem. In the third most common surgical procedure in the U.K., groin hernia repair, including 85,000 surgeries, estimated 1,500–3,000 patients will annually develop severe PPSP. While the trajectory of PPSP is generally considered a continuation of the acute post-surgery pain, recent data suggest the condition may develop with a delayed onset. This study evaluated pain-trajectories in a consecutive cohort referred from groin hernia repair-surgeons to a tertiary PPSP-center. Potential explanatory variables based on individual psychometric, sensory, and surgical profiles were analyzed.MethodsPatients completed graphs on pain trajectories and questionnaires on neuropathic pain, pain-related functional assessments, and psychometrics. Surgical records and quantitative sensory testing profiles were obtained. Pain trajectories were normalized, and pre- and post-surgical segments were analyzed by a normalized area-under-the-curve (AUC) technique. Principal component analysis (PCA) was applied to the explanatory variables. Significant PCA-components were further examined using multiple logistic regression models.ResultsIn 95 patients, the AUC identified groups of post-surgical pain trajectories (p<0.0001): group I (n=48), acute high-intensity pain progressing to PPSP; group II (n=28), delayed onset of PPSP; group III (n=7), repeat-surgery gradually inducing PPSP. Data from groups IV (n=3) and V (n=9) were not included in the statistical analysis due to small sample size and data heterogeneity, respectively. The PCA/logistic analyses indicated that neuropathic pain scores, composite pain scores, and pain-related functional assessments were explanatory variables for groups I and II.ConclusionsPain trajectories in PPSP after groin hernia repair are heterogeneous but can be classified into meaningful groups. Examination of pain trajectories, mirroring the transition from acute to severe persistent post-surgical pain, has the potential of uncovering clinically relevant pathophysiological mechanisms.

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Groin Pain After Inguinal Hernia Repair

Cited by 50 publications

References 68 publications

Patient perceptions of acute pain and activity disruption following inguinal hernia repair: a propensity-matched comparison of robotic-assisted, laparoscopic, and open approaches

Patient perceptions of acute pain and activity disruption following inguinal hernia repair: a propensity-matched comparison of robotic-assisted, laparoscopic, and open approaches

Telephone survey of inguinal hernia repair patients older than 5 years for chronic pain

Trajectories in severe persistent pain after groin hernia repair: a retrospective analysis

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