title: Long-term outcome of surgical treatment of chronic postoperative groin pain: a word of caution.
abstract: OBJECTIVE
  Chronic postoperative groin pain is widely accepted to be a serious clinical condition after inguinal hernia repair and Pfannenstiel incision. Surgical treatment has been reported to be effective, but the long-term outcome following these interventions remains unclear. This retrospective study reports the outcome and investigates patient and intra-operative factors to identify possible predictors of success. A literature review of other outcome studies with more than 1 year follow-up is also presented.
  
  
  METHODS
  A registry of patients who underwent surgery for chronic postoperative groin pain was analyzed. Pain was assessed using DN4-score and VAS-scale. Primary endpoint was successful pain reduction, as defined by the ratio of VASmax (post/pre) and the subjective outcome (better vs. same-worse).
  
  
  RESULTS
  Fifteen patients underwent surgery for chronic postoperative groin pain between December 2000 and April 2010. Overall, significant pain reduction was achieved in 1/3 of patients. There was no significant association between patient or intra-operative factors and favorable outcome. A complete concordance between subjective outcome and the ratio of VASmax (post/pre) was noted.
  
  
  CONCLUSIONS
  The success of surgery for chronic postoperative groin pain is difficult to predict. In this study, one in three patients benefits from an operative treatment. The ratio of VASmax (post/pre) is suggested as a useful pain assessment tool. A further prospective study of sufficient sample size is necessary to identify possible factors associated with favorable outcome after surgery for chronic groin pain.
authors.affiliation: Department of Abdominal Surgery, Gasthuisberg University Hospital, Katholieke Universiteit Leuven, Herestraat 49, 3000, Leuven, Belgium, evertvalvekens@gmail.com.
authors.forename: E
authors.initials: E
authors.lastname: Valvekens
authors.forename: Y
authors.initials: Y
authors.lastname: Nijs
authors.forename: M
authors.initials: M
authors.lastname: Miserez
mesh_terms: D000328:Adult; D059350:Chronic Pain / Q000601:surgery*; D020878:Device Removal; D005260:Female; D006119:Groin; D006552:Hernia, Inguinal / Q000601:surgery*; D059685:Herniorrhaphy / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009437:Neuralgia / Q000209:etiology / Q000601:surgery; D010149:Postoperative Pain / Q000601:surgery*; D012042:Registries; D012189:Retrospective Studies; D013526:Surgical Mesh; D016896:Treatment Outcome