Page 71 - International guidelines for groin hernia management

Hernia

Discussion patterns may differ depending on structures and organs
Mortality risk calculations and cause-of-death analyses involved and the type of repair performed. While certain
require large data sets. Prospective registration of opera- predisposing neuroanatomic and technical factors can be
tions facilitates these calculations and reduces selection avoided, chronic postoperative inguinal pain (CPIP)
bias, thereby making the results more representative of the remains a complex challenge with several psychological,
overall hernia surgery population. National registers are social, genetic, and behavioral influences.
useful when calculating mortality risks, since the results
can be verified and compared with national Cause-of-Death Key question
registers.
Emergent hernia surgery is associated with considerably KQ19P.a How is chronic pain defined? What is its
increased mortality. Symptom duration before diagnosis prevalence after IH repair?

and treatment delays are factors that contribute to this Key question
increased mortality.
In elective hernia repair, medical comorbidities are the KQ19P.b What are the risk factors for CPIP?
primary contributor to cause of death and must be con-
sidered when planning operations, especially in the elderly.

Evidence in literature
Chapter 19 Definition of chronic pain

In 1986, the International Association for the Study of Pain
Pain: prevention and treatment defined chronic pain as pain lasting more than 3 months. 144
This definition was considered valid in epidemiological
A. Wijsmuller, D. Chen, L. Liem, M. Loos, W. Reinpold, studies 145 and was used in randomized studies on hernia
and S. Smedberg surgery, even if pain related to surgery was not part of the
objectives when the definition was formulated.
Pain prevention However, with mesh hernia repairs, the inflammatory
Definition of chronic postoperative inguinal pain (CPIP) healing process may last longer than this defined 3-month
Chronic pain is a frequent long-term complication fol- interval due to tissue reaction to the mesh. Therefore, some
lowing nearly all surgical procedures. However, there are systematic review authors have used pain lasting 6 months
no consensus definitions of exactly what constitutes or more as a criterion for inclusion in their reviews. 146
chronic pain after specific operations. With IH repair, pain

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