The incidence and success of treatment for severe chronic groin pain after open, transabdominal preperitoneal, and totally extraperitoneal hernia repair.
BACKGROUND
Chronic groin pain (CGP) is a significant cause of postoperative morbidity after inguinal hernia repair. Open, transabdominal preperitoneal (TAPP), and totally extraperitoneal (TEP) repair are all commonly performed methods of herniorrhaphy. The aim of this study was to compare the frequency of attendance at a chronic pain clinic (CPC) for CGP after open, TAPP or TEP repair.


METHODS
A retrospective review of all inguinal hernia repairs between January 1997 and December 2006 identified patients attending the CPC for CGP post-herniorrhaphy. In this study CGP post-herniorrhaphy was defined as pain that limited daily activities despite simple analgesia thereby requiring referral to the specialist CPC following surgical review.


RESULTS
A total of 8513 patients underwent 9607 inguinal hernia repairs; 6497 (75.5%) were open, 1916 (22.3%) were TAPP, and 198 (2.3%) were TEP. Of these, 46 (0.71%) open, 22 (1.15%) TAPP, and 6 (3.03%) TEP repairs required attendance at CPC. A statistically significant difference in frequency of CPC attendance following laparoscopic versus open (P = 0.008), TEP versus open (P < or = 0.001), and TEP versus TAPP repair (P = 0.027) was observed. After an average of 1 year, 69% of patients were discharged symptom-free from the CPC. In 16%, CGP resolved prior to CPC attendance.


CONCLUSIONS
In contrast to previous reports, laparoscopic hernia repair is associated with a greater frequency of attendance at CPC than open repair, a finding that merits further investigation. Of those requiring treatment, the majority were discharged pain-free after an average of 1 year.
Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW, UK. ebright@doctors.net.uk
Elizabeth
E
Bright
Venkat M
VM
Reddy
David
D
Wallace
Giuseppe
G
Garcea
Ashley R
AR
Dennison
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D002908:Chronic Disease; D005260:Female; D006119:Groin; D006552:Hernia, Inguinal / Q000601:surgery*; D006801:Humans; D015994:Incidence; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000453:epidemiology* / Q000628:therapy*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D016896:Treatment Outcome