Abstract
Incisional hernias can be associated with pain or discomfort. Surgical repair especially mesh reinforcement, may likewise induce pain. The primary objective was to assess the incidence of pain after hernia repair in patients with and without pre-operative pain or discomfort. The secondary objectives were to determine the preferred mesh type, mesh location and surgical technique in minimizing postoperative pain or discomfort. A registry-based prospective cohort study was performed, including patients undergoing incisional hernia repair between September 2011 and May 2019. Patients with a minimum follow-up of 3-6 months were included. The incidence of hernia related pain and discomfort was recorded perioperatively. A total of 1312 patients were included. Pre-operatively, 1091 (83%) patients reported pain or discomfort. After hernia repair, 961 (73%) patients did not report pain or discomfort (mean follow-up = 11.1 months). Of the pre-operative asymptomatic patients (n = 221), 44 (20%, moderate or severe pain: n = 14, 32%) reported pain or discomfort after mean follow-up of 10.5 months. Of those patients initially reporting pain or discomfort (n = 1091), 307 (28%, moderate or severe pain: n = 80, 26%) still reported pain or discomfort after a mean follow-up of 11.3 months postoperatively. In symptomatic incisional hernia patients, hernia related complaints may be resolved in the majority of cases undergoing surgical repair. In asymptomatic incisional hernia patients, pain or discomfort may be induced in a considerable number of patients due to surgical repair and one should be aware if this postoperative complication.
Highlights
Incisional hernia is a common complication after abdominal surgery with incidence rates of more than 30% in high-risk patients, such as patients with abdominal aortic aneurysms and obese patients [1,2,3,4]
Patients who presented with a symptomatic incisional hernia were more likely to be female and had a slightly higher body mass index (BMI), compared to asymptomatic patients
This study found, similar to the current observational report, that the use of suture fixation was more beneficial with respect to postoperative pain [32]
Summary
Incisional hernia is a common complication after abdominal surgery with incidence rates of more than 30% in high-risk patients, such as patients with abdominal aortic aneurysms and obese patients [1,2,3,4]. Among pa tients there is an increased resistance for the use of surgical meshes in general, due to negative reports in media (including social media). Is this negative view of the media on incisional hernia repair causing post operative chronic pain justified? Of the pre-operative asymptomatic patients (n = 221), 44 (20%, moderate or severe pain: n = 14, 32%) reported pain or discomfort after mean follow-up of 10.5 months. In asymptomatic incisional hernia patients, pain or discomfort may be induced in a considerable number of patients due to surgical repair and one should be aware if this postoperative complication
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