Skip to main content
Top
Published in: Hernia 6/2019

01-12-2019 | Inguinal Hernia | Original Article

Is young age a risk factor for chronic postoperative inguinal pain after endoscopic totally extraperitoneal (TEP) repair?

Authors: W. J. Bakker, C. V. van Hessen, E. J. M. M. Verleisdonk, G. J. Clevers, P. H. P. Davids, N. Schouten, J. P. J. Burgmans

Published in: Hernia | Issue 6/2019

Login to get access

Abstract

Purpose

A generally known risk factor for developing chronic postoperative inguinal pain after inguinal hernia repair is young age. However, studies discussing young age as a risk factor are mainly based on open repairs. The aim of this study was to determine if young adults (age 18–30) are also more prone to experience chronic postoperative inguinal pain after totally extraperitoneal (TEP) inguinal hernia repair, compared to older adults (age ≥ 31).

Methods

A prospective study was conducted in a high-volume TEP hernia clinic in 919 patients. Patients were assessed using the Numeric (Pain) Rating Scale, Inguinal Pain Questionnaire and Carolina Comfort Scale preoperatively, at 3 months, 1 year and 2 years after TEP mesh repair. The primary outcome was clinically relevant pain in young adults compared to older adults at 3 months follow-up. Secondary outcomes were pain 1 and 2 years postoperatively, the impact of pain on daily living, foreign body feeling and testicular pain. Furthermore, age categories were analyzed to determine potential age-dependent risk factors.

Results

Follow-up was completed in 867 patients. No significant difference was found between young adults and older adults for clinically relevant pain at 3 months follow-up (p = 0.723). At all follow-up time points, no significant differences were found for clinically relevant pain, any pain, mean pain scores, the Inguinal Pain Questionnaire and the Carolina Comfort Scale. The subgroup analyses showed no age-dependent risk factor.

Conclusions

Young age is not associated with a higher risk of chronic postoperative inguinal pain after endoscopic TEP hernia repair.
Literature
1.
go back to reference Lichtenstein IL (1987) Herniorrhaphy. A personal experience with 6321 cases. Am J Surg 153:553–559CrossRef Lichtenstein IL (1987) Herniorrhaphy. A personal experience with 6321 cases. Am J Surg 153:553–559CrossRef
2.
go back to reference Langeveld HR, van’t Riet M, Weidema WF, Stassen LP, Steyerberg EW, Lange J, Bonjer HJ, Jeekel J (2010) Total extraperitoneal inguinal hernia repair compared with Lichtenstein (the LEVEL-Trial): a randomized controlled trial. Ann Surg 251:819–824CrossRef Langeveld HR, van’t Riet M, Weidema WF, Stassen LP, Steyerberg EW, Lange J, Bonjer HJ, Jeekel J (2010) Total extraperitoneal inguinal hernia repair compared with Lichtenstein (the LEVEL-Trial): a randomized controlled trial. Ann Surg 251:819–824CrossRef
3.
go back to reference Kehlet H (2008) Chronic pain after groin hernia repair. Br J Surg 95:135–136CrossRef Kehlet H (2008) Chronic pain after groin hernia repair. Br J Surg 95:135–136CrossRef
4.
go back to reference Classification of Chronic Pain (1986) Descriptions of chronic pain syndromes and definitions of pain terms. Prepared by the International Association for the Study of Pain, Subcommittee on Taxonomy. Pain Suppl 3:S1–S226 Classification of Chronic Pain (1986) Descriptions of chronic pain syndromes and definitions of pain terms. Prepared by the International Association for the Study of Pain, Subcommittee on Taxonomy. Pain Suppl 3:S1–S226
5.
go back to reference HerniaSurge Group (2018) International guidelines for groin hernia management. Hernia 22:1–165CrossRef HerniaSurge Group (2018) International guidelines for groin hernia management. Hernia 22:1–165CrossRef
6.
go back to reference Koning GG, Wetterslev J, van Laarhoven CJ, Keus F (2013) The totally extraperitoneal method versus Lichtenstein’s technique for inguinal hernia repair: a systematic review with meta-analyses and trial sequential analyses of randomized clinical trials. PLoS One 8:e52599CrossRef Koning GG, Wetterslev J, van Laarhoven CJ, Keus F (2013) The totally extraperitoneal method versus Lichtenstein’s technique for inguinal hernia repair: a systematic review with meta-analyses and trial sequential analyses of randomized clinical trials. PLoS One 8:e52599CrossRef
7.
go back to reference Bay-Nielsen M, Perkins FM, Kehlet H, Danish Hernia Database (2001) Pain and functional impairment 1 year after inguinal herniorrhaphy: a nationwide questionnaire study. Ann Surg 233:1–7CrossRef Bay-Nielsen M, Perkins FM, Kehlet H, Danish Hernia Database (2001) Pain and functional impairment 1 year after inguinal herniorrhaphy: a nationwide questionnaire study. Ann Surg 233:1–7CrossRef
8.
go back to reference Liem MS, van Duyn EB, van der Graaf Y, van Vroonhoven TJ, Coala Trial Group (2003) Recurrences after conventional anterior and laparoscopic inguinal hernia repair: a randomized comparison. Ann Surg 237:136–141CrossRef Liem MS, van Duyn EB, van der Graaf Y, van Vroonhoven TJ, Coala Trial Group (2003) Recurrences after conventional anterior and laparoscopic inguinal hernia repair: a randomized comparison. Ann Surg 237:136–141CrossRef
9.
go back to reference Dickinson KJ, Thomas M, Fawole AS, Lyndon PJ, White CM (2008) Predicting chronic post-operative pain following laparoscopic inguinal hernia repair. Hernia 12:597–601CrossRef Dickinson KJ, Thomas M, Fawole AS, Lyndon PJ, White CM (2008) Predicting chronic post-operative pain following laparoscopic inguinal hernia repair. Hernia 12:597–601CrossRef
10.
go back to reference Lau H, Patil NG (2004) Acute pain after endoscopic totally extraperitoneal (TEP) inguinal hernioplasty: multivariate analysis of predictive factors. Surg Endosc 18:92–96CrossRef Lau H, Patil NG (2004) Acute pain after endoscopic totally extraperitoneal (TEP) inguinal hernioplasty: multivariate analysis of predictive factors. Surg Endosc 18:92–96CrossRef
11.
go back to reference Bay-Nielsen M, Nilsson E, Nordin P, Kehlet H, Swedish Hernia Data Base the Danish Hernia Data Base (2004) Chronic pain after open mesh and sutured repair of indirect inguinal hernia in young males. Br J Surg 91:1372–1376CrossRef Bay-Nielsen M, Nilsson E, Nordin P, Kehlet H, Swedish Hernia Data Base the Danish Hernia Data Base (2004) Chronic pain after open mesh and sutured repair of indirect inguinal hernia in young males. Br J Surg 91:1372–1376CrossRef
12.
go back to reference Franneby U, Sandblom G, Nordin P, Nyren O, Gunnarsson U (2006) Risk factors for long-term pain after hernia surgery. Ann Surg 244:212–219CrossRef Franneby U, Sandblom G, Nordin P, Nyren O, Gunnarsson U (2006) Risk factors for long-term pain after hernia surgery. Ann Surg 244:212–219CrossRef
13.
go back to reference Bittner R, Arregui ME, Bisgaard T, Dudai M, Ferzli GS, Fitzgibbons RJ, Fortelny RH, Klinge U, Kockerling F, Kuhry E, Kukleta J, Lomanto D, Misra MC, Montgomery A, Morales-Conde S, Reinpold W, Rosenberg J, Sauerland S, Schug-Pass C, Singh K, Timoney M, Weyhe D, Chowbey P (2011) Guidelines for laparoscopic (TAPP) and endoscopic (TEP) treatment of inguinal hernia [International Endohernia Society (IEHS)]. Surg Endosc 25:2773–2843CrossRef Bittner R, Arregui ME, Bisgaard T, Dudai M, Ferzli GS, Fitzgibbons RJ, Fortelny RH, Klinge U, Kockerling F, Kuhry E, Kukleta J, Lomanto D, Misra MC, Montgomery A, Morales-Conde S, Reinpold W, Rosenberg J, Sauerland S, Schug-Pass C, Singh K, Timoney M, Weyhe D, Chowbey P (2011) Guidelines for laparoscopic (TAPP) and endoscopic (TEP) treatment of inguinal hernia [International Endohernia Society (IEHS)]. Surg Endosc 25:2773–2843CrossRef
14.
go back to reference Burgmans JP, Voorbrood CE, Schouten N, Smakman N, Elias S, Clevers GJ, Davids PH, Verleisdonk EJ, Hamaker ME, Simmermacher RK, van Dalen T (2015) Three-month results of the effect of Ultrapro or Prolene mesh on post-operative pain and well-being following endoscopic totally extraperitoneal hernia repair (TULP trial). Surg Endosc 29:3171–3178CrossRef Burgmans JP, Voorbrood CE, Schouten N, Smakman N, Elias S, Clevers GJ, Davids PH, Verleisdonk EJ, Hamaker ME, Simmermacher RK, van Dalen T (2015) Three-month results of the effect of Ultrapro or Prolene mesh on post-operative pain and well-being following endoscopic totally extraperitoneal hernia repair (TULP trial). Surg Endosc 29:3171–3178CrossRef
15.
go back to reference Burgmans JP, Voorbrood CE, Simmermacher RK, Schouten N, Smakman N, Clevers G, Davids PH, Verleisdonk EM, Hamaker ME, Lange JF, van Dalen T (2016) Long-term results of a randomized double-blinded prospective trial of a lightweight (Ultrapro) versus a heavyweight mesh (Prolene) in laparoscopic total extraperitoneal inguinal hernia repair (TULP-trial). Ann Surg 263:862–866CrossRef Burgmans JP, Voorbrood CE, Simmermacher RK, Schouten N, Smakman N, Clevers G, Davids PH, Verleisdonk EM, Hamaker ME, Lange JF, van Dalen T (2016) Long-term results of a randomized double-blinded prospective trial of a lightweight (Ultrapro) versus a heavyweight mesh (Prolene) in laparoscopic total extraperitoneal inguinal hernia repair (TULP-trial). Ann Surg 263:862–866CrossRef
16.
go back to reference Roos M, Bakker WJ, Schouten N, Voorbrood C, Clevers GJ, Verleisdonk EJ, Davids P, Burgmans J (2018) Higher recurrence rate after endoscopic totally extraperitoneal (TEP) inguinal hernia repair with Ultrapro lightweight mesh: 5-year results of a randomized controlled trial (TULP-trial). Ann Surg 268(2):214–246CrossRef Roos M, Bakker WJ, Schouten N, Voorbrood C, Clevers GJ, Verleisdonk EJ, Davids P, Burgmans J (2018) Higher recurrence rate after endoscopic totally extraperitoneal (TEP) inguinal hernia repair with Ultrapro lightweight mesh: 5-year results of a randomized controlled trial (TULP-trial). Ann Surg 268(2):214–246CrossRef
17.
go back to reference Schouten N, van Dalen T, Smakman N, Elias SG, Clevers GJ, Verleisdonk EJ, Davids PH, Burgmans IP (2012) The effect of Ultrapro or Prolene mesh on postoperative pain and well-being following endoscopic totally extraperitoneal (TEP) hernia repair (TULP): study protocol for a randomized controlled trial. Trials 13:76CrossRef Schouten N, van Dalen T, Smakman N, Elias SG, Clevers GJ, Verleisdonk EJ, Davids PH, Burgmans IP (2012) The effect of Ultrapro or Prolene mesh on postoperative pain and well-being following endoscopic totally extraperitoneal (TEP) hernia repair (TULP): study protocol for a randomized controlled trial. Trials 13:76CrossRef
18.
go back to reference Molegraaf M, Lange J, Wijsmuller A (2017) Uniformity of chronic pain assessment after inguinal hernia repair: a critical review of the literature. Eur Surg Res 58:1–19CrossRef Molegraaf M, Lange J, Wijsmuller A (2017) Uniformity of chronic pain assessment after inguinal hernia repair: a critical review of the literature. Eur Surg Res 58:1–19CrossRef
19.
go back to reference Heniford BT, Walters AL, Lincourt AE, Novitsky YW, Hope WW, Kercher KW (2008) Comparison of generic versus specific quality-of-life scales for mesh hernia repairs. J Am Coll Surg 206:638–644CrossRef Heniford BT, Walters AL, Lincourt AE, Novitsky YW, Hope WW, Kercher KW (2008) Comparison of generic versus specific quality-of-life scales for mesh hernia repairs. J Am Coll Surg 206:638–644CrossRef
20.
go back to reference Franneby U, Gunnarsson U, Andersson M, Heuman R, Nordin P, Nyren O, Sandblom G (2008) Validation of an Inguinal Pain Questionnaire for assessment of chronic pain after groin hernia repair. Br J Surg 95:488–493CrossRef Franneby U, Gunnarsson U, Andersson M, Heuman R, Nordin P, Nyren O, Sandblom G (2008) Validation of an Inguinal Pain Questionnaire for assessment of chronic pain after groin hernia repair. Br J Surg 95:488–493CrossRef
21.
go back to reference Nielsen K, Poelman MM, den Bakker FM, van der Ploeg T, Bonjer HJ, Schreurs WH (2014) Comparison of the Dutch and English versions of the Carolinas Comfort Scale: a specific quality-of-life questionnaire for abdominal hernia repairs with mesh. Hernia 18:459–464PubMed Nielsen K, Poelman MM, den Bakker FM, van der Ploeg T, Bonjer HJ, Schreurs WH (2014) Comparison of the Dutch and English versions of the Carolinas Comfort Scale: a specific quality-of-life questionnaire for abdominal hernia repairs with mesh. Hernia 18:459–464PubMed
22.
go back to reference Langeveld HR, Klitsie P, Smedinga H, Eker H, Van’t Riet M, Weidema W, Vergouwe Y, Bonjer HJ, Jeekel J, Lange JF (2015) Prognostic value of age for chronic postoperative inguinal pain. Hernia 19:549–555CrossRef Langeveld HR, Klitsie P, Smedinga H, Eker H, Van’t Riet M, Weidema W, Vergouwe Y, Bonjer HJ, Jeekel J, Lange JF (2015) Prognostic value of age for chronic postoperative inguinal pain. Hernia 19:549–555CrossRef
23.
go back to reference van Veen RN, van Wessem KJ, Halm JA, Simons MP, Plaisier PW, Jeekel J, Lange JF (2007) Patent processus vaginalis in the adult as a risk factor for the occurrence of indirect inguinal hernia. Surg Endosc 21:202–205CrossRef van Veen RN, van Wessem KJ, Halm JA, Simons MP, Plaisier PW, Jeekel J, Lange JF (2007) Patent processus vaginalis in the adult as a risk factor for the occurrence of indirect inguinal hernia. Surg Endosc 21:202–205CrossRef
24.
go back to reference Jiang ZP, Yang B, Wen LQ, Zhang YC, Lai DM, Li YR, Chen S (2015) The etiology of indirect inguinal hernia in adults: congenital or acquired? Hernia 19:697–701CrossRef Jiang ZP, Yang B, Wen LQ, Zhang YC, Lai DM, Li YR, Chen S (2015) The etiology of indirect inguinal hernia in adults: congenital or acquired? Hernia 19:697–701CrossRef
25.
go back to reference van Kerckhoven G, Toonen L, Draaisma WA, de Vries LS, Verheijen PM (2016) Herniotomy in young adults as an alternative to mesh repair: a retrospective cohort study. Hernia 20:675–679CrossRef van Kerckhoven G, Toonen L, Draaisma WA, de Vries LS, Verheijen PM (2016) Herniotomy in young adults as an alternative to mesh repair: a retrospective cohort study. Hernia 20:675–679CrossRef
26.
go back to reference Osifo OD, Irowa OO (2008) Indirect inguinal hernia in Nigerian older children and young adults: is herniorrhaphy necessary? Hernia 12:635–639CrossRef Osifo OD, Irowa OO (2008) Indirect inguinal hernia in Nigerian older children and young adults: is herniorrhaphy necessary? Hernia 12:635–639CrossRef
Metadata
Title
Is young age a risk factor for chronic postoperative inguinal pain after endoscopic totally extraperitoneal (TEP) repair?
Authors
W. J. Bakker
C. V. van Hessen
E. J. M. M. Verleisdonk
G. J. Clevers
P. H. P. Davids
N. Schouten
J. P. J. Burgmans
Publication date
01-12-2019
Publisher
Springer Paris
Keyword
Inguinal Hernia
Published in
Hernia / Issue 6/2019
Print ISSN: 1265-4906
Electronic ISSN: 1248-9204
DOI
https://doi.org/10.1007/s10029-019-01882-3

Other articles of this Issue 6/2019

Hernia 6/2019 Go to the issue