title: Long-term patterns and predictors of pain following laparoscopic inguinal hernia repair: a patient-centered analysis.
abstract: Laparoscopic inguinal hernia repair has been shown to offer patients the benefit of less postoperative pain as compared to traditional open techniques. However, the risk of experiencing significant postoperative pain may affect patient's decision making. We aimed to elucidate potential patterns of pain and the predictors of such, up to 2 years postoperatively, using both generic and specific quality of life tools.
  
  
  
  Patients undergoing laparoscopic totally extra-peritoneal inguinal hernia repair were identified from a prospectively maintained database. Short form-36, Surgical Outcomes Measurement System (SOMS) and Carolinas Comfort Scale (CCS) surveys were administered pre- and postoperatively at 3 weeks, 6 months, 1 and 2 years. Patients with concomitant procedures were excluded. Significant pain was considered mild but bothersome or worse on either specific tool (SOMS scores ≥3/4, CCS scores ≥2). Predictors of significant pain were determined by logistic regression.
  
  
  
  From 2009 to 2015, 482 patients enrolled in our database underwent elective TEP repair of 626 hernias and completed an assessment tool. Mean age was 57 (±15) years, with 93 % male. Reported pain on all three tools improved significantly from baseline over time (p < 0.01). Significant pain on either specific tool, related or unrelated to surgery, was reported by 52 % of respondents (158/301) preoperatively, and postoperatively by 50 % at 3 weeks (111/220), 21 % at 6 months (15/70), 13 % at 1 year (14/108), and 25 % at 2 years (30/121). Significant pain at 6 months-2 years correlated more significantly with general health status than surgical factors.
  
  
  
  Significant pain can be as high as 50 % at 3 weeks on surgery-specific quality of life measures, but with significant improvement by 6 months which is maintained through 2 years. Poor quality of life and general health were the main predictors of pain after 6 months.
authors: Section of Minimally Invasive Surgery, Department of Surgery, Grainger Center for Simulation and Innovation, NorthShore University HealthSystem, 2650 Ridge Avenue, Evanston, IL, 60201, USA.
authors: Lava Y
authors: LY
authors: Patel
authors: Section of Minimally Invasive Surgery, Department of Surgery, Grainger Center for Simulation and Innovation, NorthShore University HealthSystem, 2650 Ridge Avenue, Evanston, IL, 60201, USA.
authors: Brittany
authors: B
authors: Lapin
authors: Section of Minimally Invasive Surgery, Department of Surgery, Grainger Center for Simulation and Innovation, NorthShore University HealthSystem, 2650 Ridge Avenue, Evanston, IL, 60201, USA.
authors: Matthew E
authors: ME
authors: Gitelis
authors: Section of Minimally Invasive Surgery, Department of Surgery, Grainger Center for Simulation and Innovation, NorthShore University HealthSystem, 2650 Ridge Avenue, Evanston, IL, 60201, USA.
authors: Craig
authors: C
authors: Brown
authors: Section of Minimally Invasive Surgery, Department of Surgery, Grainger Center for Simulation and Innovation, NorthShore University HealthSystem, 2650 Ridge Avenue, Evanston, IL, 60201, USA.
authors: John G
authors: JG
authors: Linn
authors: Section of Minimally Invasive Surgery, Department of Surgery, Grainger Center for Simulation and Innovation, NorthShore University HealthSystem, 2650 Ridge Avenue, Evanston, IL, 60201, USA.
authors: Stephen
authors: S
authors: Haggerty
authors: Section of Minimally Invasive Surgery, Department of Surgery, Grainger Center for Simulation and Innovation, NorthShore University HealthSystem, 2650 Ridge Avenue, Evanston, IL, 60201, USA.
authors: Woody
authors: W
authors: Denham
authors: Department of Medical Social Sciences, Surgery and Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, 633 N. Saint Clair Street, 19th Floor, Chicago, IL, 60611, USA.
authors: Zeeshan
authors: Z
authors: Butt
authors: Section of Minimally Invasive Surgery, Department of Surgery, Grainger Center for Simulation and Innovation, NorthShore University HealthSystem, 2650 Ridge Avenue, Evanston, IL, 60201, USA.
authors: Ermilo
authors: E
authors: Barrera
authors: Section of Minimally Invasive Surgery, Department of Surgery, Grainger Center for Simulation and Innovation, NorthShore University HealthSystem, 2650 Ridge Avenue, Evanston, IL, 60201, USA.
authors: Ray
authors: R
authors: Joehl
authors: Section of Minimally Invasive Surgery, Department of Surgery, Grainger Center for Simulation and Innovation, NorthShore University HealthSystem, 2650 Ridge Avenue, Evanston, IL, 60201, USA.
authors: JoAnn
authors: J
authors: Carbray
authors: Section of Minimally Invasive Surgery, Department of Surgery, Grainger Center for Simulation and Innovation, NorthShore University HealthSystem, 2650 Ridge Avenue, Evanston, IL, 60201, USA.
authors: Tyler
authors: T
authors: Hall
authors: Section of Minimally Invasive Surgery, Department of Surgery, Grainger Center for Simulation and Innovation, NorthShore University HealthSystem, 2650 Ridge Avenue, Evanston, IL, 60201, USA. mujiki@northshore.org.
authors: Michael B
authors: MB
authors: Ujiki
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006552:Hernia, Inguinal / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000209:etiology*; D011788:Quality of Life
keywords: Chronic pain; Hernia repair; Inguinal groin; Quality of life; Totally extra-peritoneal (TEP) hernia repair