Is Postoperative Chronic pain Syndrome Higher with Mesh Repair of Inguinal Hernia?
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The American surgeon. Am Surg. 2010 Oct;76(10):1115-8
KRISTIN MASUKAWA, B.A., SAMUEL E. WILSON, M.D.
From the Long Beach Veterans Affairs Medical Center, Long Beach, California
Chronic postoperative pain has been associated with mesh repair in meta-analysis of clinical trials. We compared the incidence of early complications, recurrence, and chronic pain syndrome in anatomic and mesh repairs in 200 patients. We defined chronic pain syndrome as pain in the inguinal area more than 3 months after inguinal hernia repair, patient referral to pain management, or necessity of a secondary procedure for pain control. The mean follow-up time was 4 years and 2 months for anatomic repair and 3 years and 7 months for mesh repair. The clinical outcomes did not reveal a significant disparity between the 100 consecutive patients who had mesh repair versus the 100 patients who had anatomic repair with regard to the incidence of superficial wound infection (0 vs. 2%, P 5 0.497), testicular swelling (12 vs. 7%, P 5 0.335), hematoma (1 vs. 0%, P 5 0.99), recurrence (3 vs. 2%, P 5 0.99), or chronic postoperative pain (4 vs. 1%, P 5 0.369). The anatomic procedure without mesh should continue to be offered to patients who have an initial inguinal hernia repair.
Dr. Petersen's notes:
As an intern in surgery, July of 1981, I preformed the first operation of my career under the instruction of Dr. Samuel Wilson at the Wadsworth VA Hospital in Los Angeles, California. This operation was a McVay repair of an inguinal hernia.
Since then over the past 30 years I have preformed over 5,000 hernia repairs in addition to 15,000 other general surgery procedures. My career experience for hernia repair is identical to the results reported here by Dr. Wilson.
This article is very important because chronic pain after mesh inguinal hernia repair is common and because this problem is under appreciated and under reported. Also, as Dr. Wilson points out "Few younger surgeons perform open anatomic hernia repair today, believing that results are better with mesh placement." The problem of chronic pain after mesh inguinal hernia surgery is further compounded by the fact that it is so difficult to treat.
This study is limited as the author states because of its size and retrospective design. But the study is a stand out because it was not funded by a commercial interest, that is, the manufacturers of mesh and because it questions the orthodoxy of hernia surgery. Most medical research these days is funded by commercial interests which introduces bias which too frequently gets overlooked.