Page 63 - herina surgery and possible lawsuits

• Callesen et al had found that incidence of moderate to severe pain after 12 months of
surgeiy was higher after recurrent hernia (14%) than primary hernias (3%) (P<0.001)
[130]
• Poobalan et al. had found that recurrent hernia surgery associated with more chronic

pam than primary surgery (P=0 04), probably related to technically more difficult
operation with a higher risk of nerve damage. [117]

Chronic pain in relation to type of study:
There were various type of studies had been done for pam includes review article,
cross sectional cohort, meta analysis, randomized controlled trail, multicentre randomized

controlled study etc.

• Aasvang et al had reviewed article with more than/equal 100 patients and pain more

than 6 months as tool for study inclusion, studied 35 articles and published results on
age, gender, time course, preoperative pam, employment status, type of surgery, etc.
They found more pain when pain is primary outcome objective than secondary
outcome.

Less pain was reported in single centre study than multicentre study. [14]
• Bay-Nielsen et al. had studied the cross sectional cohort study using questionnaire

and found 28.7% chrome pain incidence at 1 year and is associated with functional
impairment in more than half of those with pain.[13]

Chronic pain in relation to open /Laparoscopic surgery:

• Aasvang and Kehlet in his review found that the overall mcidence of chronic pain
after hemioplasty was 12% but it was significantly higher (PO.Ol ) in which open
18% (range 0-75.5%) than laparoscopic surgery 6% (range 1~16%).[14]

• Lau et al found that the prevalence of chronic pam after TEP was 9.2%, mostly mild
and transient in nature and had negligible impact on daily activity.[131]
• The EU Hernia Collaboration had done meta- analysis of laparoscopic or open-mesh

repair showed that laparoscopic herrna repair develop significantly less (P<0.05)
chronic pam than open.[133]
• Over all meta review have shown that laparoscopic repairs (TEP and TAPP) are better

in recovery and pain, but it should made easier, safer and less expensive.[134]

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