Chronic Pain Review Following Lichtenstein Hernia Repair: A Personal Series


Introduction: Chronic groin pain is both a topical subject and important outcome measurement following inguinal hernia repair. It has been suggested its incidence is related to the management of the nerves of the inguinal canal as well as the type of mesh used and methods of fixation for both open and laparoscopic surgery. The level of pre-operative and post operative pain, its duration as well as complications may all be factors in predicting whether chronic pain could develop. The method of measurement of chronic pain is itself a contentious issue. It is now apparent that the qualitative measurement of activity and functional status as well as quantitative is important. As a result several uniform methods of assessing chronic post-operative pain have been designed, validated and implemented. One of these is used here. Methods: A study reviewing a consecutive series of Lichtenstein repairs performed by a single experienced hernia surgeon was carried out. 248 inguinal hernia patients operated on in 2005 were reviewed. Patients were contacted via telephone at a median of 50 months. Franneby’s recently validated inguinal pain questionnaire was used to assess the incidence of chronic pain. Results: 185 (75%) patients were able to be contacted for follow-up, making a total of 213 inguinal hernia repairs (including bilateral and recurrent hernias). At the time of review 3% of patients reported having pain. No patients reported that pain or discomfort was limiting their work, exercise or activities of daily living. No patients had disabling pain. Conclusion: Chronic pain did not appear to be a major problem within this cohort of patients. The Lichtenstein technique can produce favourable results in terms of chronic pain for unilateral, bilateral and recurrent inguinal hernias in an unselected group of patients with the usual mix of risk factors and complications.

Share and Cite:

M. Brygel, L. J. Bonato and S. S. Farah, "Chronic Pain Review Following Lichtenstein Hernia Repair: A Personal Series," Surgical Science, Vol. 3 No. 9, 2012, pp. 430-435. doi: 10.4236/ss.2012.39086.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] A. Kingsnorth and K. LeBlanc, “Hernias: Inguinal and Incisional,” Lancet, Vol. 362, No. 9395, 2003, pp. 1561-1571. doi:10.1016/S0140-6736(03)14746-0
[2] T. Bisgaard, et al., “Risk of Recurrence 5 Years or More after Primary Lichtenstein Mesh and Sutured Inguinal Hernia Repair,” British Journal of Surgery, Vol. 94, No. 8, 2007, pp. 1038-1040. doi:10.1002/bjs.5756
[3] H. Kehlet, “Chronic Pain after Groin Hernia Repair,” British Journal of Surgery, Vol. 95, No. 2, 2008, pp. 135-136. doi:10.1002/bjs.6111
[4] A. S. Poobalan, et al., “Chronic Pain and Quality of Life Following Open Inguinal Hernia Repair,” British Journal of Surgery, Vol. 88, No. 8, 2001, pp. 1122-1126. doi:10.1046/j.0007-1323.2001.01828.x
[5] M. Bay-Nielsen, et al., “Swedish Hernia Data Base the Danish Hernia Data B. Chronic Pain after Open Mesh and Sutured Repair of Indirect Inguinal Hernia in Young Males,” British Journal of Surgery, Vol. 91, No. 10, 2004, pp. 1372-1376. doi:10.1002/bjs.4502
[6] R. E. Condon, “Groin Pain after Hernia Repair,” Annals of Surgery, Vol. 233, No. 1, 2001, p. 8. doi:10.1097/00000658-200101000-00002
[7] H. Kehlet, et al., “Chronic Postherniorrhaphy Pain—A Call for Uniform Assessment,” Hernia, Vol. 6, No. 4, 2002, pp. 178-181. doi:10.1007/s10029-002-0082-0
[8] K. McCormack, et al., “Laparoscopic Techniques versus Open Techniques for Inguinal Hernia Repair,” Cochrane Database of Systematic Reviews, Vol. 2003, No. 1, 2003, Article ID: CD001785.
[9] K. J. Dickinson, et al., “Predicting Chronic Post-Operative Pain Following Laparoscopic Inguinal Hernia Repair,” Hernia, Vol. 12, No. 6, 2008, pp. 597-601. doi:10.1007/s10029-008-0408-7
[10] H. R. Langeveld, et al., “Total Extraperitoneal Inguinal Hernia Repair Compared with Lichtenstein (the LEVEL-Trial): A Randomized Controlled Trial,” Annals of Surgery, Vol. 251, No. 5, 2010, pp. 819-824. doi:10.1097/SLA.0b013e3181d96c32
[11] U. Franneby, et al., “Validation of an Inguinal Pain Questionnaire for Assessment of Chronic Pain after Groin Hernia Repair,” British Journal of Surgery, Vol. 95, No. 4, 2008, pp. 488-493. doi:10.1002/bjs.6014
[12] M. P. Simons, et al., “European Hernia Society Guidelines on the Treatment of Inguinal Hernia in Adult Patients,” Hernia, Vol. 13, No. 4, 2009, pp. 343-403. doi:10.1007/s10029-009-0529-7
[13] U. Franneby, et al., “Risk Factors for Long-Term Pain after Hernia Surgery,” Annals of Surgery, Vol. 244, No. 2, 2006, pp. 212-219. doi:10.1097/01.sla.0000218081.53940.01
[14] S. Lichtenstein, et al., “The Tension Free Hernioplasty,” American Journal of Surgery, Vol. 157, 1989, pp. 188-193. doi:10.1016/0002-9610(89)90526-6
[15] H. Kehlet, et al., “Persistent Postsurgical Pain: Risk Factors and Prevention,” Lancet, Vol. 367, No. 9522, 2006, pp. 1618-1625. doi:10.1016/S0140-6736(06)68700-X
[16] E. K. Aasvang, et al., “Predictive Risk Factors for Persistent Postherniotomy Pain,” Anesthesiology, Vol. 112, No. 4, 2010, pp. 957-969. doi:10.1097/ALN.0b013e3181d31ff8
[17] C. G. Schmedt, et al., “Comparison of Endoscopic Procedures vs. Lichtenstein and Other Open Mesh Techniques for Inguinal Hernia Repair: A Meta-Analysis of Randomized Controlled Trials,” Surgical Endoscopy, Vol. 19, No. 2, 2005, pp. 188-199. doi:10.1007/s00464-004-9126-0
[18] K. Caliskan, et al., “A Method for the Reduction of Chronic Pain after Tension-Free Repair of Inguinal Hernia: Iliohypogastric Neurectomy and Subcutaneous Transposition of the Spermatic Cord,” Hernia, Vol. 14, No. 1, 2010, pp. 51-55. doi:10.1007/s10029-009-0571-5
[19] J. F. M. Lange, et al., “Prophylactic Ilioinguinal Neurectomy in Open Inguinal Hernia Repair: A Double-Blind Randomized Controlled Trial,” Annals of Surgery, Vol. 246, No. 6, 2007, p. 1116. doi:10.1097/SLA.0b013e31815c2979
[20] S. Alfieri, et al., “Influence of Preservation versus Division of Ilioinguinal, Iliohypogastric, and Genital Nerves during Open Mesh Herniorrhaphy: Prospective Multicentric Study of Chronic Pain,” Annals of Surgery, Vol. 243, No. 4, 2006, pp. 553-558. doi:10.1097/01.sla.0000208435.40970.00

Copyright © 2024 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.