Impact of Mesh and Fixation on Chronic Inguinal Pain in Lichtenstein Hernia Repair: 5-Year Outcomes from the Finn Mesh S
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ORIGINAL SCIENTIFIC REPORT
Impact of Mesh and Fixation on Chronic Inguinal Pain in Lichtenstein Hernia Repair: 5-Year Outcomes from the Finn Mesh Study M. Matikainen1 • J. Vironen2 • J. Ko¨ssi3 • T. Hulmi1 • M. Hertsi4 • T. Rantanen5 • H. Paajanen5,6
Accepted: 11 October 2020 Ó The Author(s) 2020
Abstract Objective To find out the mesh fixation technique that minimises chronic pain in Lichtenstein hernioplasty. Summary background data Mesh fixation may affect chronic pain and recurrence after inguinal hernia surgery, but long-term results of comparative trials are lacking. Methods Lichtenstein hernioplasty was performed under local anaesthesia on 625 patients in day care units. The patients were randomised to receive either a cyanoacrylate glue (n = 216), self-gripping mesh (n = 202) or nonabsorbable 3–0 polypropylene sutures (n = 216) for the fixation of mesh. A standardised telephone interview or postal questionnaire was conducted 5 years after the index operation. The patients with complaints suggesting recurrence or chronic pain (visual analogue scale C 3, 0–10) were examined clinically. The rate of occasional pain, chronic severe pain, recurrence, re-operations, daily use of analgesics, overall patient satisfaction and sensation of a foreign object were recorded. Results A total of 82% of patients (n = 514) completed the 5-year audit including 177, 167 and 170 patients in the glue, self-fixation and suture groups, respectively. There were no significant differences in the incidence of pain (7–8%), operated recurrences (2–4%), overall re-operations (4–5%), need for analgesics (1–2%), patient’s satisfaction (93–97%) or in the feeling of a foreign object (11–18%) between the study groups. Conclusion The choice of the mesh or fixation method had no effect on the overall long-term outcome, pain or recurrence of hernia. Less penetrating fixation (glue or self-gripping mesh) is a safe option for the fixation of mesh in Lichtenstein hernia repair.
Introduction
& M. Matikainen [email protected] 1
North-Karelia Central Hospital, Joensuu, Finland
2
Helsinki University Hospital, Helsinki, Finland
3
Pa¨ija¨t-Ha¨me Central Hospital, Lahti, Finland
4
Savonlinna Central Hospital, Savonlinna, Finland
5
Kuopio University Hospital, Kuopio, Finland
6
Finland and Eastern University of Finland, Kuopio, Finland
During the pre-mesh era, a great number of patients suffered from prolonged pain reaction due to tension caused by sutures and they had more recurrences when compared to the Lichtenstein method [1, 2]. The number of recurrences has been reduced to 1–5% in open inguinal hernia surgery owing to the use of synthetic meshes [1]. The main drawback of modern inguinal hernia repair is still chronic pain, which may affect 10–30% of patients after surgery [3]. Chronic inguinal pain is a multifaceted complication which can be due to various surgery and patient dependent factors. The mesh material itself may cause local nerve
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World J Surg
irritation and scar tissue, although the hernioplasty performe
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