Postoperative aspects of inguinal hernia surgery Pain and recurrences
av
NIKLAS MAGNUSSON
Akademisk avhandling
Avhandling för medicine doktorsexamen i Medicinsk vetenskap med inriktning mot kirurgi,
som enligt beslut av rektor kommer att försvaras offentligt fredag den 7 december 2012 kl. 13.00,
Wilandersalen, Universitetssjukhuset Örebro Opponent: Professor Marc Miserez
Dept. of Abdominal Surgery, University Hospitals Leuven, Belgien
Örebro universitet
Institutionen för hälsovetenskap och medicin
701ಞ82 ÖREBRO
Abstract
Niklas Magnusson (2012): Postoperative aspects of inguinal hernia surgery. Pain and recurrences. Örebro Studies in Medicine 78, 56 pp.
Approximately one in four men will have surgery for ingunial hernia in their lifetime. In Sweden, 16 000 procedures are performed each year.
To investigate the possible link between handling of nerves and sensory disturbance, 97 groins in 92 patients were examined one year after inguinal hernia surgery. Sensory disturbances were found to be common after open surgery (29 %), but were not seen after the laparoscopic procedures. No significant relationship between sensory disturbance and handling of nerves or pain was seen.
The risk for recurrence has been significantly reduced due to the use of prosthetic meshes, but continued surveillance of this important outcome will always be necessary. In that context, the time frame in which recur- rence develops in relation to possible risk factors can help our understand- ing of the underlying mechanisms. To explore such temporal relationships, 142,578 patients were included in a register study. A relative over-risk for early recurrence was seen after suture repair, laparoscopic repair, after postoperative complications, and after surgery for previous recurrence.
Corticosteroids are known to decrease pain and nausea after several sur- gical procedures. In a randomised trial on open hernia surgery, 398 pa- tients were randomised to treatment with 12 mg of betamethasone or pla- cebo. Decreased levels of pain were seen on the day of surgery, the next day and after one month. No difference was seen on days 2-7 and after one year. Nausea was not common and did not differ between the groups.
Reoperation is sometimes performed to correct a presumed structural defect thought to cause the long-term pain. In order to evaluate the result of such treatment, 111 cases were analysed based on register data, ques- tionnaires and medical records. Sixty-two per-cent of the patients reported an improvement compared to before the reoperation, but a high level of pain remaining (42 %), and impaired quality of life was seen. There was no clear advantage for any surgical intervention over the other.
Keywords: Inguinal hernia, surgery, pain, reoperation, recurrence, betame- thasone, sensory disturbance, nerve, groin.
Niklas Magnusson, School of Health and Medical Sciences, IHM,
Örebro University, SE-701 82 Örebro, Sweden, niklas.magnusson@oru.se
