title: Reduced postoperative chronic pain after tension-free inguinal hernia repair using absorbable sutures: a single-blind randomized clinical trial.
abstract: BACKGROUND
  Chronic pain after inguinal hernia repair occurs in 16% to 62% of patients. The underlying mechanism probably involves sensory nerve damage and abnormal healing that might be influenced by the materials chosen for the procedure. We hypothesize that nonabsorbable sutures used for mesh fixation to the surrounding tissues are associated with higher rates of chronic groin pain after surgery.
  
  
  METHODS
  We conducted a single-blind randomized clinical trial to compare the effect of absorbable braided sutures (Vycril; Ethicon) and nonabsorbable monofilament sutures (Prolene; Ethicon) used in inguinal hernia repair on the rate of chronic pain. We assessed chronic pain using a 4-point verbal-rank scale during a 1-year postoperative follow-up period.
  
  
  RESULTS
  Study groups included 100 patients in each group. No age, sex, or hernia-side differences were observed between the study groups. Chronic pain rate after surgery was higher in the nonabsorbable monofilament suture group compared with the absorbable braided suture group (37 vs 26 patients; p = 0.056). Time to pain disappearance was longer in the nonabsorbable monofilament suture vs the absorbable braided suture group (115.3 days; 95% CI, 88-142.7 vs 77.4 days; 95% CI, 54.3-100.3; p = 0.038, respectively). A 1-year age increment reduces the risk for chronic pain occurrence by 2.2% (odds ratio = 0.978%; 95% CI, 0.961-0.995; p = 0.013). The use of nonabsorbable sutures increases the risk for chronic pain in 94.9% compared with absorbable sutures (odds ratio = 1.949; 95% CI, 1.039-3.658; p = 0.038).
  
  
  CONCLUSIONS
  Nonabsorbable suture use in inguinal hernia repair is associated with a higher rate of chronic pain and a longer time to pain disappearance as compared with absorbable sutures.
authors.affiliation: Division of Surgery, Assaf Harofeh Medical Center, Zerifin, affiliated to Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel. Electronic address: igorjer65@gmail.com.
authors.forename: Igor
authors.initials: I
authors.lastname: Jeroukhimov
authors.affiliation: Department of Plastic Surgery, Assaf Harofeh Medical Center, Zerifin, affiliated to Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: Itay
authors.initials: I
authors.lastname: Wiser
authors.affiliation: Division of Surgery, Assaf Harofeh Medical Center, Zerifin, affiliated to Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: Evgeny
authors.initials: E
authors.lastname: Karasic
authors.affiliation: Division of Surgery, Assaf Harofeh Medical Center, Zerifin, affiliated to Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: Vladimir
authors.initials: V
authors.lastname: Nesterenko
authors.affiliation: Division of Surgery, Assaf Harofeh Medical Center, Zerifin, affiliated to Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: Natan
authors.initials: N
authors.lastname: Poluksht
authors.affiliation: Division of Surgery, Assaf Harofeh Medical Center, Zerifin, affiliated to Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: Ron
authors.initials: R
authors.lastname: Lavy
authors.affiliation: Division of Surgery, Assaf Harofeh Medical Center, Zerifin, affiliated to Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: Ariel
authors.initials: A
authors.lastname: Halevy
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D059350:Chronic Pain / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D005500:Follow-Up Studies; D006552:Hernia, Inguinal / Q000601:surgery*; D059685:Herniorrhaphy / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000209:etiology / Q000517:prevention & control*; D011098:Polyglactin 910 / Q000009:adverse effects*; D011126:Polypropylenes / Q000009:adverse effects*; D016037:Single-Blind Method; D013526:Surgical Mesh; D013537:Sutures; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D011126:Polypropylenes; D011098:Polyglactin 910