title: Persistent neuropathic pain after inguinal herniorrhaphy depending on the procedure (open mesh v. laparoscopy): a propensity-matched analysis.
abstract: BACKGROUND
  A greater incidence of persistent pain after inguinal herniorrhaphy is suspected with the open mesh procedure than with laparoscopy (transabdominal preperitoneal), but the involvement of neuropathy needs to be clarified.
  
  
  METHODS
  We examined the cumulative incidence of neuropathic persistent pain, defined as self-report of pain at the surgical site with neuropathic aspects, within 6 months after surgery in 2 prospective subcohorts of a multicentre study. We compared open mesh with laparoscopy using different analysis, including a propensity-matched analysis with the propensity score built from a multivariable analysis using a generalized linear model.
  
  
  RESULTS
  Considering the full patient sample (242 open mesh v. 126 laparoscopy), the raw odds ratio for neuropathic persistent pain after inguinal herniorrhaphy was 4.3. It reached 6.8 with the propensity-matched analysis conducted on pooled subgroups of 194 patients undergoing open mesh and 125 undergoing laparoscopy (95% confidence interval 1.5-30.4, p = 0.012). A risk factor analysis of these pooled subgroups revealed that history of peripheral neuropathy was an independent risk factor for persistent neuropathic pain, while older age was protective.
  
  
  CONCLUSIONS
  We found a greater risk of persistent pain with open mesh than with laparoscopy that may be explained by direct or indirect lesion of nerve terminations. Strategies to identify and preserve nerve terminations with the open mesh procedure are needed.
authors: CH Princesse Grâce de Monaco, Anesthésie-Réanimation, Monaco.
authors: Patrick
authors: P
authors: Niccolaï
authors: CHU Clermont-Ferrand, Pôle Santé Publique, Clermont-Ferrand, Université Clermont, Clermont-Ferrand, and CNRS, ISIT, UMR6284, BP10448, Clermont-Ferrand, France.
authors: Lemlih
authors: L
authors: Ouchchane
authors: Clinique de La Louvière, Anesthésie-Réanimation, Lille, France.
authors: Maurice
authors: M
authors: Libier
authors: CHU Nice, Anesthésie-Réanimation Ouest, Hôpital de l'Archet 2, Nice, France.
authors: Fayçale
authors: F
authors: Beouche
authors: CHG Aurillac, Anesthésie- Réanimation, Aurillac, France.
authors: Monique
authors: M
authors: Belon
authors: Clinique du Tonkin, Anesthésie- Réanimation, Villeurbanne, France.
authors: Jean-Marc
authors: JM
authors: Vedrinne
authors: CHG Thiers, Anesthésie-Réanimation, Thiers, France.
authors: Bilal
authors: B
authors: El Drayi
authors: CHG Riom, Anesthésie-Réanimation, Riom, France.
authors: Laurent
authors: L
authors: Vallet
authors: CHG Vichy, Anesthésie-Réanimation, Vichy, France.
authors: Franck
authors: F
authors: Ruiz
authors: CHU Strasbourg, Pôle d'Anesthésie Réanimations chirurgicales-SAMU-SMUR, Hôpital de Hautepierre, Strasbourg, France.
authors: Céline
authors: C
authors: Biermann
authors: Clinique de la Pergola, Chirurgie, Vichy, France.
authors: Pascal
authors: P
authors: Duchêne
authors: CHG Montluçon, Anesthésie- Réanimation, Montluçon, France.
authors: Claudine
authors: C
authors: Chirat
authors: CHU Clermont-Ferrand, Centre de Pharmacologie Clinique (Inserm CIC1405), Clermont-Ferrand, France.
authors: Sylvie
authors: S
authors: Soule-Sonneville
authors: CHU Clermont-Ferrand, Centre de Pharmacologie Clinique (Inserm CIC1405), and Inserm U1107 "Neuro-Dol", Clermont-Ferrand, France.
authors: Christian
authors: C
authors: Dualé
authors: Université Clermont, CHU Clermont-Ferrand, Centre de Pharmacologie Clinique (Inserm CIC1405), Clermont-Ferrand, Inserm U1107 "Neuro-Dol", Clermont-Ferrand, France.
authors: Claude
authors: C
authors: Dubray
authors: Inserm, U1107 "Neuro-Dol", Clermont-Ferrand, and CHU Clermont-Ferrand, BLOC-ARCHI (Anesthésie-Réanimation), Clermont-Ferrand, France.
authors: Pierre
authors: P
authors: Schoeffler
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006552:Hernia, Inguinal / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009437:Neuralgia / Q000453:epidemiology*; D010147:Pain Measurement; D057216:Propensity Score; D013526:Surgical Mesh