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Chronic Post Inguinal Herniorraphy Pain:

Prevalence and Risk Factors

Moses Galukande1,2, Aminah Nakalanzi2, Michael Oling2

  1. College of Health Sciences, Makerere University

  2. International Hospital Kampala

Correspondence to: Prof. Moses Galukande, P.O Box 8177 Namuwongo Kampala.

Email: mosesg@img.co.ug

Abstract

Background: Inguinal hernia is a common surgical condition. Whereas complications associated with hernia repair are well documented, chronic post-operative groin pain has received less attention. Objective: To review the frequency and associated risk factors for chronic post herniorrhaphy groin pain at a tertiary urban hospital. Methods: A retrospective descriptive study using data retrieved from patient files and theatre logs was conducted. Only inguinal herniae patients 13 years and above were considered. ​Pain was self reported at least 3months to 2 years after repair. Results: Eighty nine patient data were analyzed. Mean aged was 40.5years, Male:Female ratio was 6:1. Fifteen (17%) patients reported pain lasting > 3 months. No significant age difference was noted between those with pain and the pain free.All those with chronic pain were male. Conclusion: Inguinodynia was common in this population. Post herniorraphy pain predictive risk factors in this population ought to be investigated.

 

Keywords: Chronic Pain, Inguinal Hernia Repair, Pain, Surgery

Ann Afr Surg. 2016;13(2): 52-5.

DOI: http://dx.doi.org/10.4314/aas.v13i2.4

Introduction

Inguinal hernia is a common surgical condition (1-3). Whereas other complications associated with their repair are well documented, chronic post-operative pain at the site of the operation is only recently been focused on (4-5). Chronic groin pain following inguinal hernia repair is a potentially incapacitating complication, and presents a diagnostic and therapeutic challenge to the clinician (6). The exact cause for the pain is not clear. However, it is believed to be due to entrapment of the ilioinguinal, iliohypogastric or genital branch of the genitofemoral nerve either in the sutures, mesh or scar tissue (7-9). This complication is related to age, gender, BMI, the operator’s experience and method used though a special interest is placed on the role of nerve damage (5,10). The purpose of this study therefore was to establish the prevalence population and described selected associated factors of chronic post inguinal hernia repair in a group of patients at a tertiary hospital in an urban setting.

Methods

This was a retrospective descriptive study conducted at an urban 150 bed private tertiary hospital, with an outpatient turnover of 80,000 patient visits a year with approximately 2400 surgical procedures (all disciplines) per annum. Patients financing for hospitalization was covered either by private health insurance or out of pocket cash payments. All patients that had undergone an inguinal hernia repair over a 24 months period 2010 – 2013 were eligible. They all had undergone either a darn plication or modified Bassini repair methods as per the operating surgeon’s preference. No mesh repairs were performed over that period. A questionnaire was used to collect data and the following variables were considered; method of repair, age, gender, occurrence of pain lasting at least 3 months(11), and recurrence of the hernia.

​Details of all patients who had undergone an inguinal hernia repair in the stated period were retrieved from the theatre logs and clinical notes. Those who had not returned for a review at the three months point were contacted via telephone for a brief interview. All patients were interviewed using preset questions about presence of pain at the operation site, duration of pain and management of the pain including analgesia or reoperation. Recurrence of hernia was confirmed by a surgical review/examination. At this facility, patients are routinely reviewed up to six months (3 visits) after repair and encouraged to return for any unscheduled visit in case of any concern such as pain, swelling, fever or other complications. This list of concerns is routinely discussed before discharge.