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Reoperation for chronic pain after groin hernia surgery: a population-based study
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
Karolinska institutet, Stockholm.
Umeå Universitet och Landstinget i Jämtland.
Kirurgkliniken, Helsingborgs lasarett.
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(English)Manuscript (preprint) (Other academic)
Abstract [en]

Introduction:

Evidence supporting any one technique used at reoperation for chronic pain after hernia surgery is lacking.

Materials and methods:

All patients who had undergone surgery for chronic pain after previous groin hernia surgery 1999-2006 were identified in the Swedish Hernia Register (n=237). Data on the surgical technique used were abstracted from the medical records. The patients were asked to answer a set of questions including SF-36, the Inguinal Pain Questionnaire (IPQ) and other questions in order to evaluate the prevalence of pain after reoperation.

Results:

The study group consisted of 95 males and 16 females, mean age 53 years. Continued pain after reoperation was present in 19 %. In 27 % of cases an intervention aimed at suspected ilioinguinal neuralgia was performed. The mesh was removed completely in 28 % and partially in 13 %. A suture at the pubic tubercle was removed in 13 % of cases.

Decrease in pain after the most recent reoperation was reported by 69 patients (62%), no change in pain by 21 patients (19%) and increase in pain in 21 patients (19%). There was no significant difference in outcome between the  techniques applied.

Conclusion:

Patients reoperated for chronic pain after hernia surgery often report a reduction in pain, but the natural course of chronic pain and selection of patients makes it difficult to draw any definite conclusions.

National Category
Medical and Health Sciences
Research subject
Surgery
Identifiers
URN: urn:nbn:se:oru:diva-26076OAI: oai:DiVA.org:oru-26076DiVA, id: diva2:557839
Available from: 2012-09-30 Created: 2012-09-30 Last updated: 2017-10-17Bibliographically approved
In thesis
1. Postoperative aspects of inguinal hernia surgery: pain and recurrences
Open this publication in new window or tab >>Postoperative aspects of inguinal hernia surgery: pain and recurrences
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Approximately one in four men will have surgery for ingunial hernia in their lifetime. In Sweden, 16 000 procedures are performed each year. To investigate the possible link between handling of nerves and sensory disturbance, 97 groins in 92 patients were examined one year after inguinal hernia surgery. Sensory disturbances were found to be common after open surgery (29 %), but were not seen after the laparoscopic procedures. No significant relationship between sensory disturbance and handling of nerves or pain was seen. The risk for recurrence has been significantly reduced due to the use of prosthetic meshes, but continued surveillance of this important outcome will always be necessary. In that context, the time frame in which recurrence develops in relation to possible risk factors can help our understanding of the underlying mechanisms. To explore such temporal relationships, 142,578 patients were included in a register study. A relative over-risk for early recurrence was seen after suture repair, laparoscopic repair, after postoperative complications, and after surgery for previous recurrence. Corticosteroids are known to decrease pain and nausea after several surgical procedures. In a randomised trial on open hernia surgery, 398 patients were randomised to treatment with 12 mg of betamethasone or placebo. Decreased levels of pain were seen on the day of surgery, the next day and after one month. No difference was seen on days 2-7 and after one year. Nausea was not common and did not differ between the groups. Reoperation is sometimes performed to correct a presumed structural defect thought to cause the long-term pain. In order to evaluate the result of such treatment, 111 cases were analysed based on register data, questionnaires and medical records. Sixty-two per-cent of the patients reported an improvement compared to before the reoperation, but a high level of pain remaining (42 %), and impaired quality of life was seen. There was no clear advantage for any surgical intervention over the other.

Place, publisher, year, edition, pages
Örebro: Örebro universitet, 2012. p. 56
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 78
Keywords
Inguinal hernia, surgery, pain, reoperation, recurrence, betamethasone, sensory disturbance, nerve, groin
National Category
Medical and Health Sciences Surgery
Research subject
Medicine
Identifiers
urn:nbn:se:oru:diva-26054 (URN)978-91-7668-902-8 (ISBN)
Public defence
2012-12-07, Wilandersalen, Universitetssjukhuset, Örebro, (USÖ), Örebro, 13:00 (English)
Opponent
Supervisors
Available from: 2012-09-28 Created: 2012-09-28 Last updated: 2017-10-17Bibliographically approved

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Magnusson, Niklas

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