Sex, Age Among Predictors of Ongoing Pain After Laparoscopic Inguinal-Hernia Repair

By David Douglas

October 16, 2020

NEW YORK (Reuters Health) - About one in 17 patients experience chronic pain following laparoscopic inguinal hernia repair (LIHR), and those at higher risk include women and younger patients, according to new findings.

Chronic pain is one of the most common and distressing long-term complications after hernia repair, but little is known about its incidence in LIHR, researchers write in Surgery.

To investigate, Dr. Michael Ujiki of NorthShore University HealthSystem, in Evanston, Illinois, and colleagues examined data on 960 patients who underwent the procedure at their institution between 2008 and 2020. The patients' mean age was 59 years and only 89 (9.3%) were women.

Patients underwent LIHR with mesh via either a totally extraperitoneal (TEP) or a transabdominal preperitoneal (TAPP) approach. All the repairs were performed by four experienced surgeons.

Following the procedure, 58 patients (6.0%) met the criteria for chronic pain based on a Carolinas Comfort Scale survey score of at least three at any point more than six months after the operation. Such a score indicates "moderate/daily symptoms."

On multivariable analysis, significant predictors of chronic pain were age under 45 years, being female and having a preoperative visual analogue pain score at or greater than one. Others included prior inguinal hernia repair on the same side and intraoperative placement of a urinary catheter.

"The rate of chronic pain development increased sharply for each additional risk factor reported," the researchers write.

Dr. Ujiki told Reuters Health by email that this type of information can be helpful when physicians obtain informed consent from patients and discuss expectations regarding pain after LIHR.

"As a retrospective study," he and his colleagues caution in their paper, "our results are limited by the data contained in the electronic medical record, and we hesitate to draw too strong a set of conclusions about the predictors for chronic pain."

Nevertheless, they say that surgeons should be "aware of these factors and counsel their patients appropriately regarding the development of chronic pain."

SOURCE: Surgery, online September 25, 2020.