N 2 (183) 2023. P. 67–73

POSTHERNIORAPHIC ILIOINGUINAL PAIN SYNDROME: A MULTIDISCIPLINARY APPROACH TO THE PROBLEM

Odesa National Medical University, Odesa, Ukraine

DOI 10.32782/2226-2008-2023-2-12

The aim of the study was to assess the prevalence of pain syndrome in patients with recurrent inguinal hernias.

Material and methods. The research was carried out on the basis of the regional clinical hospital (Odesa) in 2013–2022. 152 cases of recurrent inguinal hernias were analyzed. In 34 (22.4%) cases, hernia relapses occurred after autoplasty, 82 (53.9%) – after Lichtenschein hernioplasty. Another 36 (23.7%) had recurrence of inguinal hernia after laparoscopic hernioplasty. The sample was dominated by men (144 or 94.7%). The patients’ quality of life was assessed using the EURAHS-QoL scale. Additionally, the pain syndrome was assessed using the modified Inguinal Pain Questionnaire (IPQ) scale. Statistical processing of the obtained data was carried out by the method of variance analysis using the Statistica 14.0 software (TIBCO, USA).

The results. Chronic pain syndrome occurred in 83 (54.6%) patients operated on for inguinal hernias. At the same time, the highest frequency of chronic pain was after open autoplasty (31 cases out of 34 or 91.2%). After Lichtenstein’s hernioplasty, the frequency of chronic pain after inguinal hernia repair was 47 cases out of 82 or 57.3%. Chronic pain occurred much less often after laparoscopic hernioplasty, but overall its frequency exceeded 10% (5 out of 36 or 13.9%).

Signs of damage to the ilio-inguinal (47.0%) and ilio-femoral (39.8%) nerves were most common. The intensity of the pain syndrome averaged 4.9±0.3 points. According to EURAHS-QoL, pain intensity at rest was 3.2±0.3 points, during usual activity it was 4.7±0.3 points. Patients rated the most intense pain in the last week at the level of 6.6±0.5 points. Patients with postherniorrhagic pain syndrome assessed the impact on daytime activity at home at the level of 5.3±0.3 points, on usual activity outside the home – 6.1±0.4 points, during physical exercises and sports – 7.2±0.5 points, with heavy physical work – 7.4±0.6 points. A pronounced neuropathic component of pain was noted in 29 (34.9%) patients. Funiculodynia occurred in 12 (7.9%) cases.

Key words: inguinal hernia, chronic pain, inguinodynia, multidisciplinary approach.

REFERENCES

1. Beel E, Berrevoet F. Surgical treatment for chronic pain after inguinal hernia repair: a systematic literature review. Langenbecks Arch Surg. 2022 Mar;407(2):541-548. doi: 10.1007/s00423-021-02311-9. Epub 2021 Sep 1. PMID: 34471953.
2. Sekhon Inderjit Singh HK, Massey LH, Arulampalam T, Motson RW, Pawa N. Chronic groin pain following inguinal hernia repair in the laparoscopic era: Systematic review and meta-analysis. Am J Surg. 2022 Oct;224(4):1135-1149. doi: 10.1016/j.amjsurg.2022.05.005. Epub 2022 May 21. PMID: 35660083.
3. Bjurstrom MF, Nicol AL, Amid PK, Chen DC. Pain control following inguinal herniorrhaphy: current perspectives. J Pain Res. 2014 May 29;7:277-90. doi: 10.2147/JPR.S47005. PMID: 24920934; PMCID: PMC4045265.
4. Probert S, Cai W, Iqbal MR, Lesi OK, Haque SU, Lovett B, Walton SJ. Chronic Pain as a Complication in Open Inguinal Hernia Repair: A Retrospective Study of Consenting Practice in a Single Centre. Cureus. 2022 Apr 8;14(4):e23957. doi: 10.7759/cureus.23957. PMID: 35541304; PMCID: PMC9080789.
5. Falzone U, Santonocito C, Zanghì MG, Rinzivillo N, Provenzano D, Sapienza E, Basile F, Zanghì G. Neuropathic inguinal pain: neurectomy associated with open prosthetic hernioplasty for the prevention of post-operative pain. Ann Ital Chir. 2022;93:377-384. PMID: 36155937.
6. Magnusson N, Hedberg M, Österberg J, Sandblom G. Sensory disturbances and neuropathic pain after inguinal hernia surgery. Scand J Pain. 2010 Apr 1;1(2):108-111. doi: 10.1016/j.sjpain.2010.01.004. PMID: 29913947.
7. Wijayasinghe N, Ringsted TK, Bischoff JM, Kehlet H, Werner MU. The role of peripheral afferents in persistent inguinal postherniorrhaphy pain: a randomized, double-blind, placebo-controlled, crossover trial of ultrasound-guided tender point blockade. Br J Anaesth. 2016 Jun;116(6):829-37. doi: 10.1093/bja/aew071. PMID: 27199314; PMCID: PMC4872862.
8. Vad MV, Frost P, Rosenberg J, Svendsen SW. Persistent postoperative pain after inguinal hernia repair in relation to occupational lifting and standing/walking: a 6-month follow-up study. Occup Environ Med. 2019 Oct;76(10):712-717. doi: 10.1136/oemed-2019-105919. Epub 2019 Sep 4. PMID: 31484681.
9. Ssentongo AE, Kwon EG, Zhou S, Ssentongo P, Soybel DI. Pain and Dysfunction with Sexual Activity after Inguinal Hernia Repair: Systematic Review and Meta-Analysis. J Am Coll Surg. 2020 Feb;230(2):237-250.e7. doi: 10.1016/j.jamcollsurg.2019.10.010. Epub 2019 Nov 14. PMID: 31733327.
10. PT Surg (Portuguese Collaborative Research Group). Predictors of low quality of life after open inguinal hernia repair using the EuraHS-QoL score: prospective multicentric cohort study across 33 hospitals. Hernia. 2022 Feb;26(1):225-232. doi: 10.1007/s10029-021-02498-2. Epub 2021 Nov 2. Erratum in: Hernia. 2022 Oct;26(5):1415. PMID: 34727286.
11. Ramirez-GarciaLuna JL, Aguilar-Garcia J, Fernandez-Villafuerte R, Matinez-Jimenez MA. Validation of the Simplified Inguinal Pain Questionnaire for assessing postoperative pain and disability following hernioplasty. Surg Today. 2021 Sep;51(9):1530-1534. doi: 10.1007/s00595-021-02275-9. Epub 2021 Apr 2. PMID: 33797638; PMCID: PMC8017510.
12. Fetisov VS. Package of statistical data analysis STATISTICA. Nizhyn: Publishing House of M. Gogol Nizhyn State University; 2018. 102 p. (In Ukrainian)..
13. Plumb AA, Rajeswaran G, Abbasi MA, Masci L, Warren O, Wilson J. Contemporary imaging of inguinal hernia and pain. Br J Radiol. 2022 Jun 1;95(1134):20220163. doi: 10.1259/bjr.20220163. Epub 2022 Mar 29. PMID: 35348361.
14. Plumb AA, Rajeswaran G, Abbasi MA, Masci L, Warren O, Wilson J. Contemporary imaging of inguinal hernia and pain. Br J Radiol. 2022 Jun 1;95(1134):20220163. doi: 10.1259/bjr.20220163. Epub 2022 Mar 29. PMID: 35348361.