International guidelines for prevention and management of post-operative chronic pain following inguinal hernia surgery

Abstract

Purpose To provide uniform terminology and definition of post-herniorrhaphy groin chronic pain. To give guidelines to the scientific community concerning the prevention and the treatment of chronic groin and testicular pain. Methods A group of nine experts in hernia surgery was created in 2007. The group set up six clinical questions and continued to work on the answers, according to evidencebased literature. In 2008, an International Consensus Conference was held in Rome with the working group, with an audience of 200 participants, with a view to reaching a consensus for each question.

Chronic pain and quality of life after transinguinal preperitoneal (TIPP) inguinal hernia repair: a few tips on TIPP

“…The initial retrospective results from the TULIP group did not identify a difference in the rate of chronic pain (4.4 % TIPP versus 4.1 % Lichtenstein) [4]. Furthermore, while the results of the randomized, prospective TULIP trial demonstrated a significant difference, a 12.9 % rate of chronic pain for a Lichtenstein repair is far from enviable and far exceeds their prior results of 4.1 % or the ideal rate of 0.5 % achievable with three nerve identification and proper nerve handling [3][4][5].In this study, the authors report excellent outcomes and commendable QOL data but VAS scores were obtained only to postoperative day 30. The follow-up period is too short to draw any broader comparisons to established methods such as Lichtenstein and TEP that have well established, reproducible long-term data on outcomes including QOL, recurrence, and chronic pain.…”

“…The initial retrospective results from the TULIP group did not identify a difference in the rate of chronic pain (4.4 % TIPP versus 4.1 % Lichtenstein) [4]. Furthermore, while the results of the randomized, prospective TULIP trial demonstrated a significant difference, a 12.9 % rate of chronic pain for a Lichtenstein repair is far from enviable and far exceeds their prior results of 4.1 % or the ideal rate of 0.5 % achievable with three nerve identification and proper nerve handling [3][4][5].…”

“…While there are clear technical considerations with each operation that can predispose patients to favorable or unfavorable outcomes, there is no definite superiority of one technique over another in the incidence and prevention of pain [5]. As seen with the authors' reported large experience and excellent outcomes with TIPP, centers dedicated to refining a specific technique will likely demonstrate and publish excellent outcomes but the true incidence of pain in general clinical practice remains disturbingly high.…”

“…In addition, preperitoneal dissection can injure the main trunk of the genitofemoral nerve, its genital and femoral branches, the vas deferens, and inferior epigastric vessels within the preperitoneal space [11,12]. The authors clearly mention the importance of nerve identification [5]. However, they have very low rates of nerve identification with the ilioinguinal nerve not seen in 24.3 % of patients, the iliohypogastric nerve in 84.9 %, and the genital nerve not identified in 78.3 %.…”

“…However, they have very low rates of nerve identification with the ilioinguinal nerve not seen in 24.3 % of patients, the iliohypogastric nerve in 84.9 %, and the genital nerve not identified in 78.3 %. Although this technique is less likely to injure the iliohypogastric nerve, three nerve identification is recommended in all anterior approaches [5].…”