Ten-year Audit of Lichtenstein Hernioplasty under Local Anaesthesia Performed by Surgical Residents

Hannu Paajanen; Riitta Varjo

Disclosures

BMC Surg 

In This Article

Results

The patient characteristics were similar in both groups (Table 1). Mean operative time was shorter with a consultant than with a resident (p < 0.0001). There were no differences in the number of wound complications between the consultant and the trainees after 1 month post-operation (Table 1).

Chronic pain sensations and patient's compliance to the surgery was asked for the first time after the mean follow-up of 3 years (Table 2). One fourth of the patients announced some degree of pain in the operated area with no difference in the training level of surgeon. Only 3–4% of the patients needed occasionally pain-relieving drugs. Chronic pain was so severe in 6 patients (2.1%), that local corticosteroid injections had been used to reveal discomfort. We did not find any relation of chronic pain to nerve status at operation. Over 90% of patients felt that the operating field had healed well. The same percentage of patients was very satisfied with the day-case surgery and they would come again if necessary (Table 2). Three of the recurrences appeared in the medial border of the mesh near the pubic bone, one through a too wide external ring and one through a femoral canal. All recurrences were confirmed by re-operation. Every tenth patient felt the sensation of a foreign body in the groin area.

The long-term outcome after 10 years did not differ much from the 3 years results (Table 3). About 10% of the patients felt still the sensation of a foreign body in the groin area, and 25–30% felt some discomfort or pain at rest or during daily activities, but usually this was not disturbing. Again, there were no marked differences between the surgeon's groups (Table 3). The number of recurrence was 6/281 (2.1%) during the 10 years follow-up with no statistical difference between the surgeon groups. Chronic pain in the long-term follow-up was also measured by using a visual analogue scale. Usually the pain response was between 0–6 (mean 0.31 ± 1.0) at rest and slightly higher (mean 1.0 ± 1.8) during physical exercise with only minor non-statistical differences between the surgeons (Table 4). After 10 years of Lichtenstein hernioplasty, 3 patients with VAS scale over 5 were also treated by local infiltrations of corticosteroids. Usually corticostreoids caused some relief, but did not abolish chronic pain. During 10 years of follow-up, no patients were re-operated due to chronic pain.

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