16% pain across the board – open mesh hernia repair 2020 paper
10/09/2020 at 3:55 pm #28038
Here is a recent paper that compares three different types of mesh using what looks like a well-developed questionnaire. They found that the type of mesh did not affect the pain rate, it was about 16% for all three. It seems to be very well done, even, probably, minimizing the problem a bit.
The procedure compared was open Lichtenstein. The follow-up was one year. It’s interesting that the cutoff level in their questionnaire was “level 3 – pain present, cannot be ignored, but does not interfere with everyday activities.” Levels 1 – 3 were considered “no pain” even though “pain present cannot be ignored” is right there in the description of Level 3. I guess they tried to “down play” the results, they were bad enough as-is.
It is an easy read, even for those not expert in statistics. The world needs more work like this, followed by actions to make things better.
The case for laparoscopy cannot be made either, until they have done work like this. absence of data does not mean absence of problems.
“The question put to the patient was: ‘Grade the worst pain you have felt in the operated groin during the past week’. Pain was graded on a scale from 1 to 7: level 1 – no pain; level 2 – pain present, but easily ignored; level 3 – pain present, cannot be ignored, but does not interfere with everyday activities; level 4 – pain present, cannot be ignored, and interferes with concentration on everyday activities; level 5 – pain present, interferes with most activities; level 6 – pain present, necessitating bed rest; and level 7 – pain present, prompt medical advice sought. Levels 1–3 were considered to indicate no pain, and levels 4–7 to represent pain. Significant persistent pain 1 year after surgery was set at a level of at least 4.”
10/10/2020 at 2:45 pm #28058
I missed a point that would be more important to those under 50 years of age. 19% of people under 50 had chronic pain at one year.
Excerpt from the conclusion and results abstract –
“Results: In total, 23259 male patients provided data for analysis (response rate 70⋅6 per cent). Rates of chronic pain after repairs using regular polypropylene lightweight mesh, composite (poliglecaprone-25) polypropylene lightweight mesh and polypropylene heavyweight mesh were 15⋅8, 15⋅6 and 16⋅2 per cent
respectively. Adjusted multiple logistic regression analysis showed no significant differences between regular (odds ratio (OR) 0⋅98, 95 per cent c.i. 0⋅90 to 1⋅06) or composite (OR 0⋅95, 0⋅86 to 1⋅04) lightweight mesh versus heavyweight mesh. The most striking risk factor for chronic pain was young age; 19⋅4 per cent of patients aged less than 50years experienced pain 1year after hernia repair (OR 1⋅43, 1⋅29 to 1⋅60).
Conclusion: Patient-reported chronic pain 1year after open mesh repair of inguinal hernia was common, particularly in young men. The risk of developing chronic pain was not influenced by the type of mesh.”
- This reply was modified 1 week, 3 days ago by Good intentions.
10/10/2020 at 2:53 pm #28060
They also noted that if they raised the minimum level to 5, they still had 11% of people that had reported pain. Level’s 5, 6 and 7 are shown below. So, 11% of people had pain that interfered with most activities, if I read it right.
“Changing the definition of pain to a score of at least 5
resulted in a chronic pain rate across the whole cohort
of 11⋅1 per cent, with no significant difference between
the mesh groups.
…level 5 – pain present, interferes with most activities, level 6 – pain present, necessitating bed rest; and level 7 – pain present, prompt medical advice sought.”
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