Inguinal Hernia Management: Focus on Pain

In the Netherlands approximately 31,000 inguinal hernias are corrected yearly, making it one of the most frequently performed operations in surgery. The majority of inguinal hernia repairs is conducted in male patients older than 50 years. Since recurrence rates have been reduced to a few per cent after mesh repair, nowadays morbidity associated with open inguinal hernia repair is mainly related to chronic pain. The incidence of chronic pain has been reported to be up to 53%, however reported incidences are variable due to different defnitions of chronic pain. A working group that recently developed the European Hernia Society (EHS) guidelines for treatment of inguinal hernia estimated the overall incidence of moderate to severe chronic pain after hernia surgery to be around 10-12%. The primary endpoint in studies regarding inguinal hernia repair has been recurrence up to now. Currently, such studies have also focused on chronic pain. The choice for surgical treatment of an inguinal hernia is based on dissolving pain and discomfort associated with the hernia. Additionally, this prevents an emergency operation necessary in case of incarceration and/or strangulation of the previous harmless hernia that is associated with higher morbidity and mortality compared to elective surgery. However, the indication for elective surgery should not only depend on consideration of mortality rates that are associated with emergency and elective repair. The rate of incarceration and/or strangulation of a conservatively treated hernia, the rate of recurrence of a hernia postoperatively, contra-indications, preoperative pain and discomfort associated with the hernia, the natural course of pain and the incidence of chronic postoperative pain should also be taken into account.

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