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Very interesting papers about chronic postoperative inguinal pain (CPIP)
Here is a new paper summarizing a series of papers about CPIP. It is interesting from many different perspectives. The authors conclude that performing a prophylactic repair of the “other side” is inappropriate, based on the possibility of chronic pain as an unintended result. They show that CPIP is still significant even with laparoscopic methods. The fact that they freely discuss CPIP and acknowledge it as a problem, is significant.
But they still have left out the problem of solving the CPIP after the mesh has caused it. And they do not mention pure tissue repairs, for comparison to the other obvious alternative. So, in sum, it is still an effort to keep what has been developed and invested in. At least work is still being done to understnad the problem. Hopefully, eventually, somebody will take the chance and address the best possible series of decisions for the patient. Start at pure tissue, work up to mesh implantation.
The first three papers are linked in the summary and I have found and provided a link to the fourth in the next post. The “go ahead and do the other side” exploration approach that is being promoted in laparoscopy today is being shown to add unnecessary risk to the patient.
“Inguinal hernia surgery : aspects on chronic pain and contralateral repair
Author: Olsson, Anders”https://openarchive.ki.se/xmlui/handle/10616/48204
Excerpt –
“Abstract
Inguinal hernia is common, and the only permanent treatment is surgical repair. Approximately 16,000 hernia repairs are performed annually in Sweden. Optimized surgical technique including mesh prosthesis decreases the prevalence of recurrences and the main outcome measurement is today chronic postoperative inguinal pain (CPIP). CPIP prevalence is often reported as 10-30%.The wider use of endo-laparoscopic surgical technique has slightly decreased the prevalence of CPIP and has also offered the opportunity to perform a bilateral inguinal hernia repair, as well as exploration for occult hernias in the contralateral groin, during one procedure without additional incisions. Considering the large number of patients with CPIP it is vital to better understand the etiology and causes for the development of CPIP. It is also of interest to evaluate the benefits and risks to an extended laparoscopic procedure such as a bilateral prophylactic hernia repair.”
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“In conclusion, patient reported CPIP is a significant negative outcome following groin hernia repair that needs to be evaluated continuously. The sf-IPQ can be recommended as an evaluation tool in daily clinical practice. The postoperative complications: postoperative severe pain, hematomas, and SSI were associated with CPIP. These predictors may be related to surgical technique. Considering the relatively low incidence of subsequent contralateral hernia repairs, a routine extended exposure of the contralateral groin or a prophylactic contralateral repair cannot be recommended considering the risk for surgical complications and associated CPIP.”
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2 Replies
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With hernia repair, every aspect is all over the place. I’ve heard surgeons claiming no chronic pain, 0.5%, 1-3%, 5%, 12%, and a range of 10-30% is mentioned here.
It’s good that they realize that exploring the other side without evidence of a hernia isn’t a brilliant idea.
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Here is a link to the fourth paper.
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