title: Chronic groin pain, discomfort and physical disability after recurrent groin hernia repair: impact of anterior and posterior mesh repair.
abstract: Chronic pain and physical disability are well-known problems after primary groin hernia surgery, but the outcome after recurrent hernia surgery is much less known.
  
  
  OBJECTIVE
  To study the impact of anterior mesh repair (AMR) and posterior mesh repair (PMR) on chronic pain and disability after first recurrent groin hernia surgery in a population-based cohort derived from the Swedish Hernia Register.
  
  
  METHODS
  Consecutive unilateral, first and second recurrent hernia repairs, registered between 1998 and 2007, were included. Follow-up was performed in 2009 based on the Inguinal Pain Questionnaire (IPQ) and selective clinical examination, comparing prevalence of pain between AMR, endoscopic (E-PMR) and open posterior mesh repairs (O-PMR) after first recurrent repair. Chronic pain after a second recurrent repair was analysed.
  
  
  RESULTS
  Altogether 671 first recurrent repairs were analysed: 329 AMRs, 161 E-PMRs and 181 O-PMRs. IPQ response rate was 70.6%. If the index repair was anterior, the E-PMR was associated with a lower risk of chronic pain and disability compared to AMR [OR 0.54 (CI 0.30-0.97), p = 0.039]. The risk of chronic pain increased after a second recurrent repair. A surgeon's annual volume >5 O-PMRs was related to a lower risk compared to ≤5 [OR 0.42 (CI 0.19-0.94), p = 0.034].
  
  
  CONCLUSIONS
  Endoscopic repair for first recurrent groin hernia surgery, after an index anterior repair, was associated with less chronic pain, discomfort and disability compared to anterior approach. Chronic pain increased after a second recurrent repair. A high surgeon's volume reduced the risk of chronic pain after open posterior mesh repair.
authors.affiliation: Department of Surgery, Skåne University Hospital, 221 85, Lund, Malmö, Sweden. dan.sevonius@telia.com.
authors.forename: D
authors.initials: D
authors.lastname: Sevonius
authors.affiliation: Department of Surgery, Skåne University Hospital, 221 85, Lund, Malmö, Sweden.
authors.forename: A
authors.initials: A
authors.lastname: Montgomery
authors.affiliation: Department of Surgery, Helsingborg Hospital, Helsingborg, Sweden.
authors.forename: S
authors.initials: S
authors.lastname: Smedberg
authors.affiliation: Karolinska Institute, CLINTEC, Stockholm, Sweden.
authors.forename: G
authors.initials: G
authors.lastname: Sandblom
mesh_terms: D000368:Aged; D059350:Chronic Pain / Q000209:etiology* / Q000601:surgery; D015331:Cohort Studies; D005260:Female; D006119:Groin / Q000601:surgery; D006550:Hernia, Femoral / Q000601:surgery; D006552:Hernia, Inguinal / Q000601:surgery*; D059685:Herniorrhaphy / Q000009:adverse effects* / Q000379:methods / Q000706:statistics & numerical data; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects* / Q000379:methods / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000209:etiology* / Q000601:surgery; D012042:Registries / Q000706:statistics & numerical data*; D012086:Reoperation; D013526:Surgical Mesh; D011795:Surveys and Questionnaires
keywords: Chronic pain; Groin hernia; Hernia register; Inguinal hernia; Mesh repair; Physical disability; Preperitoneal; Recurrence; Rerecurrence; Surgeon volume