Background: Morbidity associated with open inguinal hernia repair (IH repair) mainly consists of chronic pain. The aim of this study was to identify possible disparities between state-of-the-art Lichtenstein repair, and its application in general practice. Methods: A questionnaire was mailed to all surgeons and surgical residents (n = 1,374) in the Netherlands in February 2005. The objective was to determine the state of general practice with respect to technical steps during the Lichtenstein repair that are suggested to be involved in the development of chronic pain, as recently updated by Lichtenstein's successor, Amid. Results: More than half of the respondents do not act according to the Lichtenstein guidelines with respect to surgical steps that are suggested to be involved with the origin of chronic pain of somatic origin. Compliance with Amid's guidelines with respect to the handling of the nerves is variable. Surgeons conducting high numbers of IH repair are more likely to operate according to the key principles of the state-of-the-art Lichtenstein repair. Conclusion: There is a substantial disparity between the state-of-the-art Lichtenstein repair and its application in general practice with respect to steps that are suggested to play a role in the origin of chronic groin pain.

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Keywords Chronic pain, Inguinal hernia, Neurectomy, Postoperative pain, Questionnaire
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Wijsmuller, A.R., Lange, J.F., van Geldere, D., Simons, M.P., Kleinrensink, G.J., Hop, W.C.J., & Jeekel, J.. (2007). Surgical techniques preventing chronic pain after Lichtenstein hernia repair: State-of-the-art vs daily practice in the Netherlands. Hernia: the journal of hernias and abdominal wall surgery, 11(2), 147–151. doi:10.1007/s10029-006-0177-0