DOI: http://dx.doi.org/10.18203/2349-2902.isj20181114

A comparative study of postoperative chronic pain after tension free inguinal hernia repair using absorbable versus non absorbable sutures for mesh fixation

Laxmi Narayan Meena, Somendra Bansal, Pradeep Verma, Rohit Rai

Abstract


Background: Inguinal hernia is a one of common diagnosis which is frequently encountered in routine clinical practice. The Lichtenstein technique (tension free mesh repair) is currently the gold standard in open inguinal hernia repair. Currently chronic groin pain (Inguinodynia) is one of the common complications after hernia repair and it may affect quality of life and it has been reported in 16% to 62% of the patients.

Methods: This prospective, randomized study was conducted in the department of general surgery in S.M.S. Medical College and attached group of hospitals, Jaipur from May 2014 to December 2015. All patients of 18-80 years old, who were admitted for elective inguinal hernia repair, were included for the study. Patients with bilateral, recurrent, irreducible or incarcerated hernia, pregnant patients and patients with co morbid conditions, were excluded from the study.

Results: Mean age was 46.5 years in absorbable group and 45.4 years in non absorbable group. Male to female ratio was 142:13 in absorbable group and 143:12 in non absorbable group. Post operative pain was measured by VAS score. Mean postoperative pain (VAS score) was lower in absorbable sutures group as compared to non absorbable group at 3 months (0.92±0.879 vs. 1.23±1.2; p=0.013) and at 6 months (0.48±0.57 vs. 0.77±0.65; p≤0.001), which was significant.

Conclusions: Patients with absorbable suture for mesh fixation has less groin pain as compared to non-absorbable suture in hernia repair during 6 months follow up period.


Keywords


Chronic groin pain, Inguinal hernia, Mesh, Suture

Full Text:

PDF

References


Zhao G, Gao P, Ma B, Tian J, Yang K. Open mesh techniques for inguinal hernia repair: a meta-analysis of randomized controlled trials. Ann Surg. 2009;250:35-42.

Hakeem A, Shanmugam V. Inguinodynia following Lichtenstein tension-free hernia repair: A review. World J Gastroenterol. 2011;17(14):1791-6.

van Hanswijck de Jonge P, Lloyd A, Horsfall L, Tan R, O'Dwyer PJ. The measurement of chronic pain and healthrelated quality of life following inguinal hernia repair: a review of the literature. Hernia. 2008;12:561-9.

Mui WL, Ng CS, Fung TM, et al. Prophylactic ilioinguinal neurectomy in open inguinal hernia repair: a double-blind randomized controlled trial. Ann Surg. 2006;244:27-33.

Merskey H, Bogduk N. Classification of chronic pain: descriptions of chronic pain syndromes and definitions of pain terms. InTask Force on Taxonomy of the IASP. 2nd ed. Seattle, WA: IASP Press; 1994: 209-214.

Loos MJ, Houterman S, Scheltinga MR, Roumen RM. Evaluating postherniorrhaphy groin pain: Visual Analogue or Verbal Rating Scale? Hernia. 2008;12:147-51.

EU Hernia Trialists Collaboration. Repair of groin hernia with synthetic mesh: meta-analysis of randomized controlled trials. Ann Surg. 2002;235:322-32.

Vrijland WW, van den Tol MP, Luijendijk RW, Hop WC, Busschbach JJ, de Lange DC. Randomized clinical trial of non-mesh versus mesh repair of primary inguinal hernia. Br J Surg. 2002;89:293-7.

van Veen RN, Wijsmuller AR, Vrijland WW, Hop WC, Lange JF, Jeekel J. Randomized clinical trial of mesh versus non-mesh primary inguinal hernia repair: long-term chronic pain at 10 years. Surgery. 2007;142:695-8.

Paajanen H. Do absorbable mesh sutures cause less chronic pain than nonabsorbable sutures after Lichtenstein inguinal herniorraphy? Hernia. 2002;6:26-8.

O’Dwyer PJ, Alani A, McConnachie A. Groin hernia repair: postherniorrhaphy pain. World J Surg. 2005;29:1062-5.

Smeds S, Löfström L, Eriksson O. Influence of nerve identification and the resection of nerves 'at risk' on postoperative pain in open inguinal hernia repair. Hernia. 2010;14:265-70.

Fränneby U, Sandblom G, Nordin P, Nyrén O, Gunnarsson U. Risk factors for long-term pain after hernia surgery. Ann Surg. 2006;244:212-9

Jeroukhimov I, Wiser I, Karasic E, Nesterenko V, Poluksht N, Lavy R, et al. Reduced Postoperative Chronic Pain after Tension-Free Inguinal Hernia Repair Using Absorbable Sutures: A Single-Blind Randomized Clinical Trial. J Am Coll Surg. 2014;218(1):102-7.

Paajanen H. Do absorbable mesh sutures cause less chronic pain than nonabsorbable sutures after Lichtenstein inguinal herniorraphy? Hernia. 2002;6:26-8.