Surgical technique and chronic postoperative inguinal pain in patients undergoing open Inguinal Hernioplasty in Portugal: a prospective multicentric cohort study

Santos, Irène; Simões, Joana F. F.; Dias, Cláudia Camila; Alves, Mafalda Sampaio; Azevedo, José; Cunha, Miguel; João, Ana Alagoa; Nobre, José Guilherme; Picciochi, Maria; Soares, António Sampaio; Vieira, Bárbara; Peyroteo, Mariana

http://hdl.handle.net/10400.1/26373

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Authors

Santos, Irène

Simões, Joana F. F.

Dias, Cláudia Camila

Alves, Mafalda Sampaio

Azevedo, José

Cunha, Miguel

João, Ana Alagoa

Nobre, José Guilherme

Picciochi, Maria

Soares, António Sampaio

Abstract(s)

Introduction: Evidence about the advantage of Lichtenstein’s repair, the guidelines’ recommended technique, is scarce regarding postoperative chronic inguinal pain (CPIP). The primary aim of this study was to compare CPIP in patients undergoing Lichtenstein versus other techniques. Methods: Prospective multicentric cohort study including consecutive adults undergoing elective inguinal hernia repair in Portuguese hospitals (October - December 2019). Laparoscopic and mesh-free hernia repairs were excluded. The primary outcome was postoperative pain at three months, defined as a score of ≥ 3/10 in the European Hernia Society Quality of Life score pain domain. The secondary outcome was 30-day postoperative complications.Results: Eight hundred and sixty-nine patients from 33 hospitals were included. Most were men (90.4%) and had unilateral hernias (88.6%). Overall, 53.6% (466/869) underwent Lichtenstein’s repair, and 46.4% (403/869) were treated with other techniques, of which 83.9% (338/403) were plug and patch. The overall rate of CPIP was 16.6% and 12.2% of patients had surgical complications. The unadjusted risk was similar for CPIP (OR 0.76, p = 0.166, CI 0.51 - 1.12) and postoperative complications (OR 1.06, p = 0.801, CI 0.69 - 1.60) between Lichtenstein and other techniques. After adjustment, the risk was also similar for CPIP (OR 0.83, p = 0.455, CI 0.51 - 1.34) and postoperative complications (OR 1.14, p = 0.584, CI 0.71 - 1.84).Conclusion: The Lichtenstein technique was not associated with lower CPIP and showed comparable surgical complications. Further investigation as-sessing long term outcomes is necessary to fully assess the benefits of the Lichtenstein technique regarding CPIP.