Factors associated with postoperative chronic pain and recurrence after laparoscopic total extraperitoneal inguinal hernia repair

Abstract

Objective: To assess the risk factors for chronic pain and recurrence after laparoscopic total extraperitoneal (TEP) inguinal hernia repair. Methods: Data of the patients who underwent laparoscopic TEP repair were analyzed. Clinical and surgical characteristics, including learning curve, mesh weight, the pore size of the mesh, use of mesh fixation, and fixation methods, were assessed. Fixation by absorbable or nonabsorbable tackers was performed in all procedures except for self-fixating meshes. Mesh brands were tiered into groups regarding pore size and weight. Operative time was defined as the duration between skin incision and dressing. The minimum follow-up was 24 months. Postoperative chronic pain was defined as moderate to severe groin pain, which was accepted as a Visual Analog score ≥3 longer than three months. Pain and recurrence were evaluated at 1 and 6 weeks in clinic visits and at 3, 12, and 24 months by telephone questionnaires. The occurrence of a fascial defect in physical examination or ultrasound was defined as recurrence. Results: Three-hundred and eighty-two procedures were included. Postoperative chronic pain was seen in 31 (8.1%) patients and was higher with micropore mesh (p=0.004), mesh fixation (p=0.002), fixation with titanium tacks (p<0.001) and at first 50 cases (p=0.043). Fifteen (3.9%) patients had a recurrence. Older age (p=0.046), prolonged operative time (p=0.040), body mass index (BMI) (p=0.008) and learning curve (p=0.034) were significantly associated with higher recurrence rate. In multivariate analysis pore size [Odds ratio (OR): 2.911, 95% confidence interval (CI): 1.153-7.351, p=0.024] and fixation with titanium tacks (OR: 8.776, 95% CI: 4.040-14.893, p=0.004) were independent risk factors for chronic pain; BMI (OR: 1.307-95% CI:1.138-1.501, p<0.001) was the only independent risk factor for recurrence. Conclusion: The outcome of laparoscopic TEP repair is related to the technic as well as patient-based factors. Titanium tacks and micropore meshes increase postoperative pain risk without any benefit on recurrence. Patients with higher BMI have an increased recurrence risk.