title: Recurrence and pain three years after groin hernia repair. Validation of postal questionnaire and selective physical examination as a method of follow-up.
abstract: OBJECTIVE
  To evaluate recurrence rate and chronic groin pain three years after hernia repair and to validate a postal questionnaire with selective physical examination as a method of follow-up.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  County hospital, Sweden.
  
  
  METHODS
  Prospective data were retrieved from the Swedish Hernia Register for patients aged 15-80 years at the time of groin hernia repair, operated on during 1994.
  
  
  METHODS
  Three years after operation patients were mailed a three-item questionnaire and invited to have a physical examination. Those examined answered a detailed questionnaire about pain and functional impairment. When appropriate an extended physical examination was undertaken to find out the probable cause of the pain.
  
  
  METHODS
  Recurrence, pain, and functional impairment.
  
  
  RESULTS
  272 hernias were repaired in 264 patients. 24 patients had died and 16 had a recurrence before the follow-up examination. After a median observation time of 44 months, 218 patients with 223 repairs (96%) were examined. Depending on the definition of recurrence and completeness of physical examination (selective or all patients) the recurrence rate varied between 10% (25/239) and 15% (35/239) including recurrences diagnosed before follow-up. 40 patients (18%) reported groin pain at follow-up, which was considered to be caused by a previous hernia repair in 34 (15%), 12 of whom (5%) had moderate or severe pain. Postoperative complications were associated with an increased risk of chronic pain, whereas type of hernia and use of mesh had no influence.
  
  
  CONCLUSIONS
  The incidence of recurrence and chronic pain after hernia repair requires continuous audit in non-specialised units. Participation in a register and follow-up by a three-item questionnaire and selective physical examination provides a solid basis for quality control.
authors.affiliation: Department of Surgery, University Hospital, Linköping, Sweden. Staffan.Haapaniemi@lio.se
authors.forename: Staffan
authors.initials: S
authors.lastname: Haapaniemi
authors.forename: Erik
authors.initials: E
authors.lastname: Nilsson
mesh_terms: D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D006550:Hernia, Femoral / Q000453:epidemiology / Q000601:surgery*; D006552:Hernia, Inguinal / Q000453:epidemiology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000453:epidemiology*; D010808:Physical Examination; D011183:Postoperative Complications / Q000453:epidemiology; D012008:Recurrence; D012042:Registries / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D013997:Time Factors