Author name:
حازم عبد الرحمن جمعه ذياب الهيتي
Supervisor name:
هشام احمد الاطرقجي
Key words:
- postoperative pain
- inguinal hernia
- postoperative pain
Abstract:
Background Indirect inguinal hernia is a common problem in people of any age & any social level. Inguinal hernia repair is a common procedure in general surgery. Increased awareness of pain after hernia repair motivated an evaluation of this pain.
Objectives To evaluate pain after indirect inguinal hernia repair by modified Bassini procedure, regarding type of pain, severity, and to identify risk factors associated with its occurrence.
Patients and methods: A prospective , clinical case series, descriptive, non-consecutive study, that included (230 ) indirect inguinal hernia repairs in males over 12 years ; at Al jumhoory Teaching Hospital in Mosul city, from the 1 st November 2011 to 31 st December 2013. All patients involved in this study, were prepared & informed with comprehensive written consent. The assessment of pain depends on verbal rating scale (simple descriptive pain intensity scale) & a special forma were applied .The surgeons who operated the patients' hernia are consultants surgeons (or residents under supervision of professionals) working at Al jumhoory Teaching Hospital, had taken their permission to follow their patients by telephone questionnaire for pain after inguinal hernia repair. The patients were followed in a regular follow up schedule in the (first week) for immediate early pain, six weeks for assessment of types of pain, twelve months for assessment of pain severity & its relation to usual work. .The data were collected, arranged in tables & analyzed. Exclusion criteria : Female patients, Males under 12 years, Direct inguinal hernias, Repair by mesh, Repair by hernhiotomy alone, Emergency procedure, Infections, Forty patients (15 %) who were lost to follow up, all patients without pain (free of pain), laparascopic repair and recurrent hernias.
Results The study included (230) males over the age of 12 years, have indirect inguinal hernia, 154 of cases (67 %) were right, 76 of cases (33 %) were left. There were 219 patients (95.3 %) who reported early transient mild groin pain in the first week after surgery, they responded well to NSAID, while 11 (4.7 %) cases reported severe postoperative pain in the first week. Then after 6 weeks, there were 184 cases (80 %) free of pain, 46 cases (20 %) had pain, from those who had pain 16 cases (7 %) developed somatic pain, 17 cases (7.3%) developed neuropathic pain, 13 patients (5.6 %) had testicular pain . After 12 months ,there were 170 cases (74 %) free of pain , 60 cases (26 %) had pain, of those who had pain 30 patients (13 %) had mild pain ,who could tolerate it, without NSAID, while 9 cases (4 %) had moderate pain occurs after heavy work & they used NSAID on need. There were 21 cases (9 %) developed chronic pain, that affects some of the patient usual activities .There were 230 patients (85 %) of patients responded to follow up (response rate).
Conclusion The presence of early transient pain after inguinal hernia repair is common in the first week then it decreases gradually after that. Early severe postoperative pain is an indication for chronic pain, which is a significant problem that affects the patient's usual activities. Three types of pain are present (Somatic, neuropathic, & testicular) .Predictive risk factors are: severe pain in the first week postoperative & early return to his usual work.
