Chronic pain following Lichtenstein tension free inguinal hernia repair

Abstract

Introduction & Objective: Chronic pain following the repair of inguinal hernia has been a topic of interest in the past few decades, probably due to its significant adverse impacts on the quality of life of the patients who undergo the procedure. In this study we assessed the site, severity and incidence of chronic pain following Lichtenstein tension free inguinal hernia repair and its association with preoperative duration of hernia, presence of preoperative groin pain, presence of inguinoscrotal hernia, type of hernia and several preoperative risk factors for inguinal hernia. Methods: Single unit prospective study conducted for a period of one year in Colombo South Teaching Hospital included patients who underwent standard Lichtenstein tension free inguinal hernia repair. Intervieweradministered pre-designed questionnaire was completed in the preoperative and post-operative stages. Postoperatively, patients were reviewed after 3 months to assess the presence of pain according to the International Association of the Study of Pain (ISAP) criteria. Severity of pain was evaluated with Wong-Baker FACES pain rating scale. Results: Total of 98 patients underwent surgery but only 80 patients returned for the review. Twenty eight (35%) patients had pain and all were males. All of them had intermittent pain. Nature of the pain was aching in 71.4%, pricking in 14.3%, burning in 7.1% and constricting in 7.1%. Pain closer to the pubic tubercle was reported by 28% while 42% had pain closer to the mid inguinal point. Pain closer to the umbilicus was reported by 21% while 7% had pain over the scrotum. Only 14.3 % were on treatment for the pain, mostly simple oral analgesics. Moderately severe pain was reported by 14% and rest of them complained of mild pain only. Constipation had a significant association with the incidence of chronic pain following Lichtenstein repair but smoking, preoperative duration of hernia, presence of preoperative groin pain, presence of an inguinoscrotal hernia, type of hernia or the other preoperative risk factors for inguinal hernia, such as weight lifting, chronic cough, prostatism had no statistically significant associations with the incidence of chronic pain following Lichtenstein tension free inguinal hernia repair. Conclusion: Nearly one third of patients reported varying degree of pain following Lichtenstein tension free inguinal hernia repair but it was a mild aching pain which was tolerable and did not require analgesics in the majority. In most cases, this pain was related to the mid-inguinal point or the pubic tubercle. Constipation showed significant associations with the incidence of pain following Lichtenstein tension free inguinal hernia repair. Galle Medical Journal, Vol 18: No. 2, September 2013; Page 1-6 DOI: http://dx.doi.org/10.4038/gmj.v18i2.6192