Long term evaluation of pain, sexual discomfort, and comparison of pain assessment scales after inguinal hernia surgery

Abstract:Background:Chronic postoperative inguinal pain (CPIP) affecting daily activities is reported in 8-12% and moresevere pain between 0.6-6% after inguinal hernia repair. CPIP incidences are based on a variety ofPROMs and definitions of pain, making comparison between studies difficult. Pain during sexualactivity (SEX-P) is rarely studied in randomized settings. Few RCTs with large cohorts report onCPIP after 5-year follow-up. The TEPLICH RCT compares TEP to Lichtenstein repair in men withprimary inguinal hernia, in a setting where all surgeons were department-certified hernia-specialists,trained according to the same curriculum. Long-term CPIP, SEX-P and comparison of three painassessment instruments were the study´s main objectives.Paper I compare 416 patients regarding short-term outcomes, CPIP, recurrence, QoL and sensorydisturbances up to 3 years. No difference in CPIP, recurrence or QoL was observed but TEP hadshorter operative time, shorter time to recovery, less complications and sensory changes.Paper II compare the subgroup of 30–60-year-old men regarding SEX-P, without differencesbetween groups up to 3 years.Paper III is a long-term questionnaire- and patient record-based follow-up including 322 patients,mean 8 years after surgery. CPIP present at 3 years persisted without differences between groups.No additional recurrence occurred after 3 years.Paper IV evaluates VAS, Cunningham pain scale and Inguinal Pain Questionnaire for correlation andinterchangeability between scales. Interchangeability couldn’t be confirmed between any of the painscales. Optimized VAS cut-offs based on Cuningham categories were calculated.Conclusion: TEP showed favorable short-term outcomes and less sensory changes. No differencesin CPIP, SEX-P, recurrence or QoL were found at any follow-up occasion. Compared PROMs werenot interchangeable underlining the difficulties in comparing pain between studies, and motivates theuse of 2 PROMs when evaluating pain. Calculated optimal VAS cut-offs may be used as a referencein future studies.