title: Predictors of chronic groin discomfort after laparoscopic totally extraperitoneal inguinal hernia repair.
abstract: BACKGROUND
  Chronic groin discomfort is an undesired complication of laparoscopic totally extraperitoneal (TEP) inguinal hernia repairs. We examined whether perioperative factors may be associated with an increased risk of developing this problem and if their recognition could lead to preventive strategies.
  
  
  METHODS
  We performed a retrospective review of 1 surgeon's experience with 1,479 TEP repairs on 976 patients from 1995 to 2009. A mailed survey, which included a groin discomfort questionnaire (Carolinas Comfort Scale), was distributed to all patients. Symptom severity grading (range 0, none to 5, severe) was used to sort individual responses. Perioperative factors were compared between asymptomatic and symptomatic patients with varying levels of discomfort.
  
  
  RESULTS
  There were 691 patients (71%) who provided complete responses to the questionnaire. Median follow-up was 5.7 years (range 0 to 14.4 years). The majority (n = 543, 79%) denied any symptoms of mesh sensation, pain, or movement limitation. In the remaining 148 (21%) patients, symptoms were most often mild (n = 108), followed by mild but bothersome (n = 25), and 15 patients (2%) had moderate or severe symptoms. Symptomatic patients were younger (median age 52 vs 57 years, p = 0.002) and were more likely to have had the TEP repair for recurrent hernias (24% vs 17%, p = 0.035). Operative diagnosis, bilateral exploration, mesh fixation techniques, perioperative complications, American Society of Anesthesiologists grade, and length of hospital stay were not associated with chronic groin discomfort.
  
  
  CONCLUSIONS
  The majority of patients are asymptomatic after a laparoscopic TEP inguinal hernia repair. Most of the symptomatic patients do not have any bothersome symptoms. Given that younger age and a repair for recurrent hernia were predictors of chronic groin discomfort, we counsel these patients about their increased risks.
authors: Department of Surgery, College of Medicine, Mayo Clinic, Rochester, MN 55905, USA.
authors: Shahzad M
authors: SM
authors: Ali
authors: Benjamin
authors: B
authors: Zendejas
authors: Siddhant
authors: S
authors: Yadav
authors: Roberto C
authors: RC
authors: Hernandez-Irizarry
authors: Christine M
authors: CM
authors: Lohse
authors: David R
authors: DR
authors: Farley
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D059350:Chronic Pain / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D006119:Groin; D006552:Hernia, Inguinal / Q000601:surgery*; D059685:Herniorrhaphy / Q000295:instrumentation / Q000379:methods; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors; D013526:Surgical Mesh; D011795:Surveys and Questionnaires; D055815:Young Adult