Patient-reported chronic pain after open inguinal hernia repair with lightweight or heavyweight mesh: a prospective, patient-reported outcomes study

Abstract

Background: Chronic pain after groin hernia repair is a significant problem, and it is unclear whether or not lightweight meshes help. This national register-based study investigated whether patients who underwent open anterior mesh inguinal hernia repair with lightweight mesh had less chronic pain than those who had hernia repair with heavyweight mesh. Methods: All patients registered in the Swedish Hernia Register between September 2012 and October 2016 were asked to complete a questionnaire assessing patient-reported outcome measures 1 year after surgery. The present study examined open anterior repair with mesh sutured in place with non-absorbable sutures in male patients only. The primary endpoint, chronic pain, was defined as pain present in the past week that could not be ignored and interfered with concentration (on chores) and daily activities. Results: In total, 23 259 male patients provided data for analysis (response rate 70⋅6 per cent). Rates of chronic pain after repairs using regular polypropylene lightweight mesh, composite (poliglecaprone-25) polypropylene lightweight mesh and polypropylene heavyweight mesh were 15⋅8, 15⋅6 and 16⋅2 per cent respectively. Adjusted multiple logistic regression analysis showed no significant differences between regular (odds ratio (OR) 0⋅98, 95 per cent c.i. 0⋅90 to 1⋅06) or composite (OR 0⋅95, 0⋅86 to 1⋅04) lightweight mesh versus heavyweight mesh. The most striking risk factor for chronic pain was young age; 19⋅4 per cent of patients aged less than 50 years experienced pain 1 year after hernia repair (OR 1⋅43, 1⋅29 to 1⋅60). Conclusion: Patient-reported chronic pain 1 year after open mesh repair of inguinal hernia was common, particularly in young men. The risk of developing chronic pain was not influenced by the type of mesh.

Mesh versus non‐mesh repair of groin hernias: a rapid review

“…The results show that age is a risk factor for chronic pain, with younger patients (<40 years) reporting increased pain levels compared to older patients, regardless of the repair technique 19–21 . Similar results were found in studies that solely investigated mesh techniques, indicating that the presence of mesh may not be the cause of pain following groin hernia repair 30,31 . Other influencing factors not captured by the present study include preoperative pain, surgical technique (open or laparoscopic), surgery for recurrence and nerve injury 32 …”

“…[19][20][21] Similar results were found in studies that solely investigated mesh techniques, indicating that the presence of mesh may not be the cause of pain following groin hernia repair. 30,31 Other influencing factors not captured by the present study include preoperative pain, surgical technique (open or laparoscopic), surgery for recurrence and nerve injury. 32 Hernia recurrence was significantly lower following mesh repair in four included meta-analyses.…”

Total extraperitoneal (TEP) versus laparoscopic transabdominal preperitoneal (TAPP) hernioplasty: systematic review and trial sequential analysis of randomized controlled trials

“…The authors affirmed that the peritoneal incision and closure with continuous suture may be responsible for high pain scores for TAPP repair. However, not only the peritoneal incision is determinant of postoperative pain, but also several factors including patients' subjective pain perception and expression, different protocols for anesthesia, postoperative analgesia, methods for mesh fixation (tacks vs. glue vs. self-gripping), mesh type, and weight (g/m 2 ) have been shown to be additional causes of postoperative pain [56][57][58][59]. While our results seem to support equivalent Surgeon experience, expertise, variation in technical skills, and hospital volume are key determinants for operative time while TAPP and TEP have been shown to be associated with a steep learning curve [60,61].…”

Evaluation of long‐term chronic pain and outcomes for unilateral vs bilateral circular incision transabdominal preperitoneal inguinal hernia repair

“…Postoperative questionnaires are a common method to investigate the long-term prognosis when patients do not visit the hospital for follow-up. 3,[13][14][15][16][17] In this study, the primary endpoints were the frequency and degree of chronic pain, and the secondary endpoints were other postoperative complications, such as recurrence.…”

“…Unlike cancer surgery, few institutions conduct long‐term surveillance for inguinal hernia repair; thus, visiting the hospital for follow‐up is difficult. Postoperative questionnaires are a common method to investigate the long‐term prognosis when patients do not visit the hospital for follow‐up 3,13–17 . In this study, the primary endpoints were the frequency and degree of chronic pain, and the secondary endpoints were other postoperative complications, such as recurrence.…”