Evaluation of long-term chronic pain and outcomes for unilateral vs bilateral circular incision transabdominal preperitoneal inguinal hernia repair.

ABSTRACT

Aim: This study has two aims: to evaluate long-term chronic pain and complications after circular incision transabdominal preperitoneal inguinal hernia repair (C-TAPP) and compare outcomes of unilateral and bilateral inguinal hernia cases. Methods: A postoperative patient questionnaire was used to evaluate pain and complications in 1546 patients who underwent C-TAPP for simple inguinal hernia. Questions concerned satisfaction with surgery, pain at rest, pain at movement, mesh discomfort on a 10-point scale, and complications, such as recurrence. Patients were classified into unilateral (U Group) and bilateral (B Group) groups, and propensity score matching was performed to compare long-term chronic pain and complications. Results: The questionnaire return rates were 77.5% (1034 cases) and 79.9% (135 cases) in unilateral and bilateral cases. The frequency of moderate-to-severe (≥4 points) pain at rest, pain at movement, and mesh discomfort were 3.2%, 3.6%, and 4.5%, respectively. After propensity score matching, no significant differences in pain at rest (P = .726), at movement (P = .712), or mesh discomfort (P = .981) were detected between the U and B groups. Postoperative complications occurred in 2.1% of all patients, and the recurrence rate was 0.3%. In the post-match comparison, no differences in complications with Clavian-Dindo classification ≥III (U Group 0.7%, B Group 2.1%, P = .622) were detected. Conclusion: C-TAPP, which focuses on the layered structure, showed acceptable results for long-term chronic pain. Bilateral cases did not have worse pain or complications compared to unilateral cases.