Postoperative hypoesthesia and pain: qualitative assessment after open and laparoscopic inguinal hernia repair.
BACKGROUND
Chronic pain is an important outcome variable after inguinal hernia repair that is generally not assessed by objective methods. The aim of this study was to objectively investigate chronic pain and hypoesthesia after inguinal hernia repair using three types of operation: open suture, open mesh, and laparoscopic.


METHODS
A total of 96 patients were included in the study with a median follow-up of 4.7 years. Open suture repair was performed in 40 patients (group A), open mesh repair in 20 patients (group B), and laparoscopic repair in 36 patients (group C). Hypoesthesia and pain were assessed using von Frey monofilaments. Quality of life was investigated with Short Form 36.


RESULTS
Pain occurring at least once a week was found in 7 (17.5%) patients of group A, in 5 (25%) patients of group B, and in 6 (16.6%) patients of group C. Area and intensity of hyposensibility were increased significantly after open nonmesh and mesh repair compared to those after laparoscopy (p = 0.01). Hyposensibility in patients who had laparoscopic hernia repair was significantly associated with postoperative pain (p = 0.03). Type of postoperative pain was somatic in 19 (61%), neuropathic in 9 (29%), and visceral in 3 (10%) patients without significant differences between the three groups.


CONCLUSIONS
The incidence of hypoesthesia in patients who had laparoscopic hernia repair is significantly lower than in those who had open hernia repair. Hypoesthesia after laparoscopic but not after open repair is significantly associated with postoperative pain. Von Frey monofilaments are important tools for the assessment of inguinal hypoesthesia and pain in patients who had inguinal hernia repair allowing quantitative and qualitative comparison between various surgical techniques.
Beldi
Guido
G
Department of Visceral and Transplantation Surgery, Inselspital Bern, 3010, Bern, Switzerland. guido.beldi@insel.ch
Haupt
Non
N
Ipaktchi
Ramin
R
Wagner
Markus
M
Candinas
Daniel
D
D000328:Adult; D017677:Age Distribution; D000368:Aged; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006552:Hernia, Inguinal / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D006987:Hypesthesia / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology*; D015994:Incidence; D010535:Laparoscopy / Q000009:adverse effects* / Q000379:methods; D007813:Laparotomy / Q000009:adverse effects* / Q000379:methods; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis* / Q000453:epidemiology; D017060:Patient Satisfaction; D011336:Probability; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D013526:Surgical Mesh; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome
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