Department of Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands.
Department of Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands.
Int J Surg. 2022 Sep;105:106837. doi: 10.1016/j.ijsu.2022.106837. Epub 2022 Aug 18.
Inguinal hernia (IH) repair is a common surgical procedure. Focus has shifted from recurrences to chronic postoperative inguinal pain (CPIP). To assess the natural course of CPIP and identify patient factors influencing the onset of CPIP, an observational registry-based study was performed.
Data prospectively collected from the Club-Hernie national database was retrieved from 2011 until 2021. Patients who underwent elective surgery for inguinal hernia were divided in an irrelevant pain group and relevant pain group. Relevant pain at one year and two years were compared with patients with irrelevant pain at all-time points (preoperatively, one month, one year and two years). Quality of life questions were compared between relevant pain at one year and two years.
4.016 patients were included in the analysis. Mean age was 65.1 years, 90.3% of patients was male. Factors correlated with CPIP onset were age, gender, ASA, recurrent surgery, surgical technique, nerve handling and fixation type. Relevant pain at one month was a greater risk for CPIP than preoperative pain (12.3% vs 3.6%). In the majority of patients (83.2%) CPIP was ameliorated at two years. Hernia related complaints differed significantly between CPIP at one year and two years.
Postoperative pain after one month was a greater risk factor for CPIP development than preoperative pain. CPIP at one year seems to have a different pain etiology than CPIP at two years. Patient and surgical factors influence the onset of CPIP at one year, however the natural course of these complaints shows great decline at two years, largely without reinterventions.
腹股沟疝（IH）修补术是一种常见的外科手术。目前的研究重点已从复发转移到慢性术后腹股沟疼痛（CPIP）。为了评估 CPIP 的自然病程，并确定影响 CPIP 发病的患者因素，进行了一项基于观察性注册研究。
从 2011 年到 2021 年，从 Club-Hernie 国家数据库中前瞻性收集数据。将接受择期腹股沟疝手术的患者分为无关疼痛组和相关疼痛组。比较一年和两年时的相关疼痛与所有时间点（术前、术后一个月、一年和两年）无关疼痛的患者。比较一年和两年时相关疼痛的生活质量问题。
共纳入 4016 例患者。平均年龄为 65.1 岁，90.3%的患者为男性。与 CPIP 发病相关的因素包括年龄、性别、ASA、复发性手术、手术技术、神经处理和固定类型。术后一个月的相关疼痛比术前疼痛更易发生 CPIP（12.3% vs. 3.6%）。在大多数患者（83.2%）中，CPIP 在两年时得到缓解。CPIP 一年和两年时的疝相关症状存在显著差异。
术后一个月的疼痛比术前疼痛是 CPIP 发展的更大风险因素。CPIP 一年时的疼痛病因似乎与 CPIP 两年时的疼痛病因不同。患者和手术因素影响 CPIP 一年时的发病，但这些症状的自然病程在两年时显示出明显下降，很大程度上无需再次干预。
