title: Surgical techniques preventing chronic pain after Lichtenstein hernia repair: state-of-the-art vs daily practice in the Netherlands.
abstract: BACKGROUND
  Morbidity associated with open inguinal hernia repair (IH repair) mainly consists of chronic pain. The aim of this study was to identify possible disparities between state-of-the-art Lichtenstein repair, and its application in general practice.
  
  
  METHODS
  A questionnaire was mailed to all surgeons and surgical residents (n = 1,374) in the Netherlands in February 2005. The objective was to determine the state of general practice with respect to technical steps during the Lichtenstein repair that are suggested to be involved in the development of chronic pain, as recently updated by Lichtenstein's successor, Amid.
  
  
  RESULTS
  More than half of the respondents do not act according to the Lichtenstein guidelines with respect to surgical steps that are suggested to be involved with the origin of chronic pain of somatic origin. Compliance with Amid's guidelines with respect to the handling of the nerves is variable. Surgeons conducting high numbers of IH repair are more likely to operate according to the key principles of the state-of-the-art Lichtenstein repair.
  
  
  CONCLUSIONS
  There is a substantial disparity between the state-of-the-art Lichtenstein repair and its application in general practice with respect to steps that are suggested to play a role in the origin of chronic groin pain.
authors.affiliation: Department of Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
authors.forename: A R
authors.initials: AR
authors.lastname: Wijsmuller
authors.forename: J F M
authors.initials: JF
authors.lastname: Lange
authors.forename: D
authors.initials: D
authors.lastname: van Geldere
authors.forename: M P
authors.initials: MP
authors.lastname: Simons
authors.forename: G J
authors.initials: GJ
authors.lastname: Kleinrensink
authors.forename: W C J
authors.initials: WC
authors.lastname: Hop
authors.forename: J
authors.initials: J
authors.lastname: Jeekel
authors.forename: J F
authors.initials: JF
authors.lastname: Lange
mesh_terms: D002908:Chronic Disease; D019983:Guideline Adherence; D006552:Hernia, Inguinal / Q000601:surgery*; D006801:Humans; D009426:Netherlands; D010149:Postoperative Pain / Q000209:etiology* / Q000517:prevention & control*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D013526:Surgical Mesh; D011795:Surveys and Questionnaires