Background and Objectives:The role of long-term degradable implants in reducing the risk of chronic postoperative pain after inguinal hernia repair is still unclear. A pilot study using a synthetic long-term resorbable mesh in Lichtenstein repair showed good results regarding pain and discomfort in patients with indirect inguinal hernia (IH) without recurrences, but higher recurrence rate in patients with direct inguinal hernia (DH). The purpose of this study was to assess the incidence of pain and early recurrence in patients with LIH surgically treated with the TEP technique using a long-term degradable mesh. This is the first human study to use long-term degradable mesh with the TEP approach.Methods:This study was prospective, including 35 primary IHs surgically treated with TEP repair using TIGR Mesh (Novus Scientific Pte, Ltd, Singapore). At the 1-year follow-up recurrence was assessed by clinical examination and the incidence of pain or discomfort was assessed before and after surgery by Visual Analog Scale (VAS) and Inguinal Pain Questionnaire (IPQ).Results:After 12 months, no patients had chronic pain. Only 1 (2.8%) patient reported pain using the VAS (score = 2), and 4 patients reported pain that could easily be ignored. All 4 patients reported less pain 1 year after the operation using both IPQ and VAS, compared with the preoperative assessment. One patient (2.8%) developed a recurrence 20 months after the primary operation.Conclusion:TEP repair using a synthetic long-term resorbable mesh was found to be safe and promising regarding pain and discomfort at 1-year follow-up in patients with IH. Longer follow-up is necessary to establish the risk of recurrence.

Introduction Synthetic non-resorbable mesh is almost standard in hernia surgery. However, several studies have showed negative effects of permanent implants such as chronic inflammation and complications involving different organs bordering the mesh. Such complications can raise the risk of chronic post-operative pain (CPP). Recently promising results regarding CPP have been published in patients with Lateral Inguinal Hernia (LIH) using a slowly resorbable mesh in Lichtenstein technique. For this reason the aim of the present study was to find the effect of a slowly resorbable implant on the long-term rate of hernia recurrence and chronic post-operative pain in patients with LIH repaired with TEP procedure. Methods Prospective pilot study of TEP repair using TIGR ® Matrix Surgical Mesh in 35 primary LIH. At 3-year followup the Visual Analogue Scale (VAS) and the Inguinal Pain Questionnaire were employed to assess pain. Recurrence was determined by ultrasound and clinical examination. Results All patients completed the pain questionnaires but one patient did not attend the planned clinical examination for the 3-year follow-up. No patients had CPP, as defined in the World Guidelines for Groin Hernia Management. Almost all patients had lower VAS score in any activity 3 years following surgery in comparison to the preoperative period. Three patients (8.8%) suffered symptomatic recurrence during the 3-year follow-up. Conclusion TEP repair in patients with LIH using a synthetic long-term resorbable mesh was found to be encouraging respecting chronic post-operative pain at 3-year follow-up but at the cost of an increased risk of recurrence.

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Aim There is a discrepancy between the high frequency of chronic post-operative pain reported in questionnaire-based studies after groin hernia surgery and the clinical experience of many surgeons in which it is infrequent that patients return after surgery because of chronic post-operative pain. This is supported by the Swedish Hernia Registry, where the proportion of patients who are re-operated for chronic post-operative pain is 0.02-0.03% for open methods and less than 0,01% for laparo-endoscopic methods. The aim of this study is to find the incidence of non-surgical causes of chronic groin pain and other patient-reported outcomes after inguinal hernia surgery. Material and Methods Prospective cohort observation study of patients evaluated for suspected inguinal hernia-related symptoms at a hernia clinic in Sweden during 1 year. Patients completed validated pain forms before surgery and 6 and 12 months after surgery. Patients were assessed preoperatively about the possible causes of groin pain according to a checklist. For this purpose, a questionnaire of inguinal hernia-related symptoms was used. Patients with moderate or severe chronic groin pain after surgery were offered to participate in a clinical examination where the pain was evaluated for probable cause according to a checklist. Results 574 patients were included in the study, of which 372 were operated on and answered the post-operative questionnaires. Preliminary results on surgical and non-surgical causes of chronic groin pain after hernioplasty and other patient-reported outcomes will be presented at Hernia 2021 EHS-AHS Joint Congress. Conclusions Proportion of patients with chronic groin pain related to groin hernia surgery and other non-surgical pathologies will be reported.