title: Factors Determining Outcome After Surgery for Chronic Groin Pain Following a Lichtenstein Hernia Repair.
abstract: BACKGROUND
  Some patients develop chronic groin pain after a Lichtenstein hernia repair. Previous studies have demonstrated beneficial effects of removal of entrapped inguinal nerves or a meshectomy in patients with chronic pain after open inguinal hernia mesh repair. Factors determining success following this remedial surgery are unknown. The aim of the study was to identify potential patient- or surgery-related factors predicting the surgical efficacy for inguinodynia following Lichtenstein repair.
  
  
  METHODS
  Consecutive adult patients with a history of persistent pain following Lichtenstein repair who underwent remedial surgery were analysed using univariate analysis. Significant confounders (p < 0.05) were combined in a multivariate logistic regression model using a backward stepwise regression method.
  
  
  RESULTS
  A total of 136 groin pain operations were available for analysis. Factors contributing to success were removal of a meshoma (OR 4.66) or a neuroma (OR 5.60) and the use of spinal anaesthesia (OR 4.38). In contrast, female gender (OR 0.30) and preoperative opioid use (OR 0.38) were significantly associated with a less favourable outcome. Using a multivariate analysis model, surgery under spinal anaesthesia (OR 4.04), preoperative use of opioids (OR 0.37), and meshoma removal (OR 5.31) greatly determined surgical outcome.
  
  
  CONCLUSIONS
  Pain reduction after remedial surgery for chronic groin pain after Lichtenstein repair is more successful if surgery is performed under spinal anaesthesia compared to general anaesthesia. Removal of a meshoma must be considered as success rates are optimized following these measures. Patients using opioids preoperatively have less favourable outcomes.
authors.affiliation: Department of General Surgery, Máxima Medical Centre, De Run 4600, P.O. Box 7777, 5500 MB, Veldhoven/Eindhoven, The Netherlands. willemzwaans@gmail.com.
authors.forename: Willem A R
authors.initials: WA
authors.lastname: Zwaans
authors.affiliation: Department of General Surgery, Máxima Medical Centre, De Run 4600, P.O. Box 7777, 5500 MB, Veldhoven/Eindhoven, The Netherlands.
authors.forename: Tim
authors.initials: T
authors.lastname: Verhagen
authors.affiliation: Department of General Surgery, Máxima Medical Centre, De Run 4600, P.O. Box 7777, 5500 MB, Veldhoven/Eindhoven, The Netherlands.|SolviMáx, Centre of Excellence for Abdominal Wall and Groin Pain, Eindhoven, The Netherlands.
authors.forename: Rudi M H
authors.initials: RM
authors.lastname: Roumen
authors.affiliation: Department of General Surgery, Máxima Medical Centre, De Run 4600, P.O. Box 7777, 5500 MB, Veldhoven/Eindhoven, The Netherlands.|SolviMáx, Centre of Excellence for Abdominal Wall and Groin Pain, Eindhoven, The Netherlands.
authors.forename: Marc R M
authors.initials: MR
authors.lastname: Scheltinga
mesh_terms: D000328:Adult; D000368:Aged; D000775:Anesthesia, Spinal; D059350:Chronic Pain / Q000601:surgery*; D005260:Female; D006119:Groin; D006552:Hernia, Inguinal / Q000601:surgery*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000601:surgery*