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Surgical Endoscopy

, Volume 34, Issue 2, pp 946–953 | Cite as

Chronic pain after two laparoendoscopic inguinal hernia repairs compared with laparoendoscopic repair followed by the Lichtenstein repair: an international questionnaire study

  • Stina ÖbergEmail author
  • Kristoffer Andresen
  • Hanna Nilsson
  • Eva Angenete
  • Jacob Rosenberg
Article

Abstract

Background

The best repair of a recurrent inguinal hernia after primary laparoendoscopic repair is debatable. The aim was to assess chronic pain after two laparoendoscopic repairs in the same groin compared with Lichtenstein reoperation preceded by a laparoendoscopic repair.

Methods

This cohort study included adult patients who had received two laparoendoscopic repairs (Lap–Lap) or a laparoendoscopic repair followed by the Lichtenstein repair (Lap–Lich). Eligible patients were identified in the Danish and the Swedish hernia databases. Lap–Lap was matched 1:3 with Lap–Lich, and patients were sent validated questionnaires. The primary outcome was the proportion with chronic pain-related functional impairment, compared between the two groups. Secondary outcomes included chronic pain during various activities.

Results

In total, 74% (546 patients) responded to the questionnaires with a median follow-up since the second repair of 4.9 years (0.9–21.9 years). Regarding the primary outcome, 21% in Lap–Lap and Lap–Lich had chronic pain-related functional impairment of daily activities (p = 0.94). More patients in Lap–Lap compared with Lap–Lich reported pain ≥ 20 mm measured by the visual analog scale, 11% versus 5%, p = 0.04. However, there was no difference in the median VAS score or in the vast majority of the remaining secondary outcomes.

Conclusions

There was no overall difference in chronic pain between patients who had received Lap–Lap compared with Lap–Lich. Choice of operative strategy for the second repair should, therefore, not be based on risk of chronic pain.

Keywords

Chronic pain Questionnaires Inguinal hernia recurrence Reoperation Laparoendoscopic repair Lichtenstein repair 

Notes

Funding

The A.P. Møller Foundation for the Advancement of Medical Science contributed with financial support to cover the operational expenses of questionnaires, postal stamps, and envelopes. The contribution was solely financial without influence on the study process.

Compliance with ethical standards

Disclosure

Jacob Rosenberg reports personal fees from Bard and Merck, outside the submitted work. Stina Öberg, Kristoffer Andresen, Hanna Nilsson, Eva Angenete reports no potential conflicts of interest and financial ties to disclose.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Center for Perioperative Optimization, Department of Surgery, Herlev HospitalUniversity of CopenhagenCopenhagenDenmark
  2. 2.Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Scandinavian Surgical Outcomes Research GroupSahlgrenska University Hospital ÖstraGothenburgSweden

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