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Cooperative Hernia Study: Pain in the Postrepair Patient

Cunningham, Johann M.D.*; Temple, Walley J. M.D.; Mitchell, Philip M.D.; Nixon, James A. M.D.; Preshaw, Roy M. M.D.; Hagen, Neil A. M.D.

Review Article

Background The Cooperative Hernia Study assessed postoperative pain in a prospective trial as part of a larger study looking at the recurrence rate and other morbidity of the Bassini, McVay, and Shouldice repairs.

Methods Patients were randomized to one of three surgical hernia repairs. Patients were seen in follow-up at 6, 12, and 24 months and were assessed for the presence of pain, numbness, paresthesia, and recurrence.

Results Three hundred fifteen patients were seen in follow-up, with 276 seen at the 2-year mark. At 1 year, 62.9% of patients had groin or inguinal pain and 11.9% of patients had moderate to severe pain; 53.6% had pain and 10.6% of patients continued to report moderate to severe pain 2 years postoperatively. The predictors for long-term postoperative pain were as follows: absence of a visible bulge before the operation (p < 0.001); presence of numbness in the surgical area postoperatively (p < 0.05); and patient requirement of more than 4 weeks out of work postoperatively (p < 0.004). Three distinct chronic pains were identified. The most common and most severe pain was somatic, localized to the common ligamentous insertion to the pubic tubercle. The second was neuropathic and was referable to the ileoinguinal or genitofemoral nerve distribution. This was likely because of injury to the genitofemoral nerves, either at surgery or subsequently by encroachment of scar. The third pain was visceral, ejaculatory pain. Twenty-four percent of patients had postoperative numbness at 2 years, independent of the type of repair. Numbness was most common in the distribution of cutaneous branches of the ilioinguinal and iliohypogastric nerves.

Conclusion Pain or numbness are common late sequelae of traditional external surgical hernia repairs. Strategies need to be developed to reduce the risk of these complications.

From the Division of General Surgery / Department of Surgery, Dalhousie University,* Halifax, Nova Scotia, Canada; and the Division of General Surgery/Department of Surgery† and the Department of Clinical Neurosciences, ‡ University of Calgary, Calgary, Alberta, Canada

Supported by the Research and Development Fund (Foothills Hospital), project number 431.

Address reprint request to Walley J. Temple, M.D., Tom Baker Cancer Centre, 1331-29 Street NW, Calgary, AB T2N 4N2 Canada.

Accepted for publication May 10, 1995.

© Lippincott-Raven Publishers.