title: Early pain after laparoscopic inguinal hernia repair. A qualitative systematic review.
abstract: BACKGROUND
  Early post-operative pain after laparoscopic groin hernia repair may, as in other laparoscopic operations, have its own individual pain pattern and patient-related predictors of early pain. The purpose of this review was to characterise pain within the first post-operative week after transabdominal pre-peritoneal repair (TAPP) and total extraperitoneal repair (TEP), and to identify patient-related predictors of early pain.
  
  
  METHODS
  A qualitative systematic review was conducted. Pubmed, Embase, CINAHL, and the Cochrane database were searched for studies on early pain (first week) after TAPP or TEP.
  
  
  RESULTS
  We included 71 eligible studies with 14,023 patients. Post-operative pain is most severe on day 0 and mainly on a level of 13-58 mm on a visual analogue scale and decreases to low levels on day 3. There seems to be no difference in pain intensity and duration when TEP and TAPP are compared. Deep abdominal pain (i.e. groin pain/visceral pain) dominates over superficial pain (i.e. somatic pain) and shoulder pain (i.e. referred pain) after TAPP. Predictors of early pain are young age and pre-operative high pain response to experimental heat stimulation. Furthermore, evidence supported early pain intensity as a predictive risk factor of chronic pain after laparoscopic groin hernia repair.
  
  
  CONCLUSIONS
  Early pain within the first week after TAPP and TEP is most severe on the first post-operative day, and the pain pattern is dominated by deep abdominal pain. Early post-operative pain is most intense in younger patients and can be predicted by pre-operative high pain response to experimental heat stimulation.
authors.affiliation: Department of Surgery, Køge Hospital, University of Copenhagen, Denmark. mette.astrup@gmail.com
authors.forename: M A
authors.initials: MA
authors.lastname: Tolver
authors.forename: J
authors.initials: J
authors.lastname: Rosenberg
authors.forename: T
authors.initials: T
authors.lastname: Bisgaard
mesh_terms: D015746:Abdominal Pain / Q000453:epidemiology / Q000209:etiology; D059787:Acute Pain / Q000453:epidemiology; D000328:Adult; D000367:Age Factors; D000368:Aged; D059350:Chronic Pain / Q000453:epidemiology; D018450:Disease Progression; D005260:Female; D005544:Forecasting; D006119:Groin; D006552:Hernia, Inguinal / Q000473:pathology / Q000601:surgery*; D006358:Hot Temperature; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000453:epidemiology*; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D012189:Retrospective Studies; D012737:Sex Factors; D020069:Shoulder Pain / Q000453:epidemiology / Q000209:etiology; D059265:Visceral Pain / Q000453:epidemiology / Q000209:etiology