Predictive Risk Factors for Persistent Postherniotomy Pain

Aasvang, Eske Kvanner; Gmaehle, Eliza; Hansen, Julie Bolvig; Gmaehle, Bjorn; Forman, Julie Lyng; Schwarz, Jochen; Bittner, R.; Kehlet, Henrik

doi:10.1097/aln.0b013e3181d31ff8

Cited by 357 publications

(263 citation statements)

References 53 publications

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“…This trend was the same when looking only at mild or only at moderate/severe pain [7]. A prospective study in 464 patients undergoing endoscopic or open hernia repair revealed factors such as preoperative Activity Assessment Scale (AAS) score [54], open surgery and 30-day postoperative pain intensity as being risk factors for chronic pain [55]. The randomised study by Singh et al [56] showed that preoperative pain, younger age, open surgery and 7-day postoperative pain were independent risk factors for chronic pain.…”

Section: Causes and Risk Factors Of Chronic Painmentioning

confidence: 90%

Update with level 1 studies of the European Hernia Society guidelines on the treatment of inguinal hernia in adult patients

Miserez

Peeters

Aufenacker

et al. 2014

Hernia

366

226

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Purpose: In 2009, the European Hernia Society published the EHS Guidelines for the Treatment of Inguinal Hernia in Adult Patients. The Guidelines contain recommendations for the treatment of inguinal hernia from diagnosis till aftercare. The guidelines expired January 1, 2012. To keep them updated, a revision of the guidelines was planned including new level 1 evidence. Methods: The original Oxford Centre for Evidence-Based Medicine ranking was used. All relevant level 1A and level 1B literature from May 2008 to June 2010 was searched (Medline and Cochrane) by the Working Group members. All chapters were attributed to the two responsible authors in the initial guidelines document. One new chapter on fixation techniques was added. The quality was assessed by the Working Group members during a 2-day meeting and the data were analysed, especially with respect to any change in the level and/or text of any of the conclusions or recommendations of the initial guidelines. In the end, all relevant references published until January 1, 2013 were included. The final text was approved by all Working Group members. Results: For the following topics, the conclusions and/or recommendations have been changed: indications for treatment, treatment of inguinal hernia, day surgery, antibiotic prophylaxis, training, postoperative pain control and chronic pain. The addendum contains all current level 1 conclusions, Grade A recommendations and new Grade B recommendations based on new level 1 evidence (with the changes in bold). Conclusions: Despite the fact that the Working Group responsible for it tried to represent most kinds of surgeons treating inguinal hernias, such general guidelines inevitably must be fitted to the daily practice of every individual surgeon treating his/her patients. There is no doubt that the future of guideline implementation will strongly depend on the development of easy to use decision support algorithms tailored to the individual patient and on evaluating the effect of guideline implementation on surgical outcome. At the 35th International Congress of the EHS in Gdansk, Poland (May 12-15, 2013), it was decided that the EHS, IEHS and EAES will collaborate from now on with the final goal to publish new joint guidelines, most likely in 2015

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Section: Causes and Risk Factors Of Chronic Painmentioning

confidence: 90%

Update with level 1 studies of the European Hernia Society guidelines on the treatment of inguinal hernia in adult patients

Miserez

Peeters

Aufenacker

et al. 2014

Hernia

366

226

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“…The mean hospital stay was 1-3 days (2.1±0.8) in group A and 2-6 days (3.7±1.5) in group B. In the other hand, the mean time to return work was 8.2±1.15 (7-10) days in group A while in group B was 11.2±2.3 (7)(8)(9)(10)(11)(12)(13)(14)(15) . Therefore, the mean time off from work in group A was 10.3±1.95 days and in group B was 14.9±3.8 (P <0.05).…”

Section: Resultsmentioning

confidence: 97%

A comparative study to evaluate the outcome between open posterior preperitoneal versus open anterior tension free hernioplasty in cases of recurrent inguinal hernia

Charpot

Chauhan

2016

Int Surg J

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Background:The ideal method for repair of inguinal hernia would cause minimal discomfort to the patient, both during the surgical procedure and in the postoperative course. It would be technically simple to perform and easy to learn, would have a low rate of complications and recurrence, and would require only a short period of convalescence. However, the most effective method in any given patient is not clearly defined and consequently surgery for recurrent inguinal hernia after mesh repair is usually a difficult operation due to the disadvantage of re-operating through dense fibrotic scar tissue around the mesh with the risk of testicular damage and a large number of local hematoma. To avoid the disadvantage of re-operating through scar tissue and dense fibrotic scar tissue around the mesh, the open posterior pre peritoneal mesh repair was popularized by Nyhus as a good alternative for recurrent inguinal hernias. In previous study, Saber and co-workers reported that open pre peritoneal hernia repair offers many advantages over the trans inguinal repair for recurrent hernia. This approach gives results far superior to those of the commonly used anterior approach. Methods: Patients in this study were divided consecutively in two main groups: A and B. Group A patients were subjected to open posterior preperitoneal approach, those of group B were subjected to transinguinal anterior tensionfree repair. All of our patients were gentlemen with total number was 60 patients; 30 for each group, their ages ranged between 42 and 65 years. The study duration was from January 2009 to January 2011 in department of general surgery, B.J Medical college and civil hospital, Ahmedabad, India. Results: There was no statistical difference between the two groups regarding patients' age and body mass index. Age ranged between 42 and 65 years with a mean age as 53.5 years. The mean operative time in group A was 71.3 min±25.2 (40-120). In group B, the mean value was 94.5 min±28.5 (60-150). The mean hospital stay was 1-3 days (2.1 ± 0.8) in group A and 2-6 days (3.7 ± 1.5) in group B. In the other hand, the mean time to return work was 8.2±1.15 (7-10) days in group A while in group B was 11.2 ± 2.3 (7-15) . Therefore, the mean time off from work in group A was 10.3 ± 1.95 days and in group B was 14.9±3.8 (P < 0.05).Chronic postoperative pain was observed in 4 patients in group A (13.33%) , in 9 patients in group B (30%). Conclusions: In recurrent inguinal hernia, the open posterior approaches are more effective in term of operative outcome. The open pre peritoneal hernia repair offers many advantages. It is inexpensive, has a low recurrence rate, and allows the surgeon to cover all potential defects with one piece of mesh. Postoperative recovery is short and postoperative pain is minimal. This approach gives results far superior to those of the commonly used anterior approach.

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“…The results with detailed assessment of neurophysiological function in the surgical area, characteristics and intensity H. Kehlet (&) Section for Surgical Pathophysiology, Rigshospitalet Copenhagen University, Copenhagen, Denmark e-mail: henrik.kehlet@rh.dk and social consequences [5] of the persistent pain showed, as with most of the other studies [1], that there was about 50% less risk of persistent pain after the laparoscopic repair, and with a lower intensity. The detailed neurophysiological assessments showed, for the Wrst time, less sign of nerve damage with the laparoscopic mesh repair with glue Wxation [7]. However, probably the most important Wnding of this study was that the pre-operative function of the nociceptive system, i.e.…”

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confidence: 77%

“…Furthermore, although chronic post-herniorrhaphy pain has been considered mostly to be of neuropathic origin [6], the documentation for neuropathic versus chronic inXammatory pain has been extremely scarce [6]. However, recently, a large two-centre prospective study has been published among 442 patients, with, for the Wrst time, a detailed description of all pre-, intra-and post-operative risk factors for the development of persistent post-herniotomy pain [7]. In this study, two high-volume centres were chosen (one in Copenhagen and one in Stuttgart), each performing either a well-established Lichtenstein repair or a laparoscopic transabdominal pre-peritoneal (TAPP) repair.…”

mentioning

confidence: 99%

Laparoscopic versus open groin hernia repair: are we getting closer to specific clinical recommendations?

Kehlet

2010

Hernia

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Predictive Risk Factors for Persistent Postherniotomy Pain

Abstract: PPP is related to both patient and surgical factors. Patients with a high preoperative AAS score and high pain response to a standardized heat stimulus may preferably be treated using an operative technique with lowest risk for nerve damage.

Cited by 357 publications

References 53 publications

Update with level 1 studies of the European Hernia Society guidelines on the treatment of inguinal hernia in adult patients

Update with level 1 studies of the European Hernia Society guidelines on the treatment of inguinal hernia in adult patients

A comparative study to evaluate the outcome between open posterior preperitoneal versus open anterior tension free hernioplasty in cases of recurrent inguinal hernia

Laparoscopic versus open groin hernia repair: are we getting closer to specific clinical recommendations?

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