Risk prediction model for chronic pain after laparoscopic preperitoneal inguinal hernia repair_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

YU Zhiyuan , YANG Shiyu , LIU Bowen , ZHANG Xu ,  SUN Yan

Seventh Department of General Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin 150081, P. R. China;

Corresponding author：

SUN Yan, Email: sunyandoctor@163.com

Keywords：

laparoscopic preperitoneal inguinal hernia repair; chronic pain; inguinal hernia; risk prediction model

DOI：

10.7507/1007-9424.202108045

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To explore the risk factors of chronic postoperative inguinal pain (CPIP) after transabdominal preperitoneal hernia repair (TAPP), establish and verify the risk prediction model, and then evaluate the prediction effectiveness of the model. Methods The clinical data of 362 patients who received TAPP surgery was retrospectively analyzed and divided into model group (n=300) and validation group (n=62). The risk factors of CPIP in the model group were screened by univariate analysis and multivariate logistic regression analysis, and the risk prediction model was established and tested. Results The incidence of CPIP at 6 months after operation was 27.9% (101/362). Univariate analysis showed that gender (χ²= 12.055, P=0.001), age (t=–4.566, P<0.01), preoperative pain (χ²=44.686, P<0.01) and early pain at 1 week after operation (χ²=150.795, P<0.01) were related to CPIP. Multivariate logistic regression analysis showed that gender, age, preoperative pain, early pain at 1 week after operation, and history of lower abdominal surgery were independent risk predictors of CPIP. The area under curve (AUC) of the receiver operating characteristic (ROC) of the risk prediction model was calculated to be 0.933 [95%CI (0.898, 0.967)], and the optimal cut-off value was 0.129, while corresponding specificity and sensitivity were 87.6% and 91.5% respectively. The prediction accuracy, specificity and sensitivity of the model were 91.9% (57/62), 90.7% and 94.7%, respectively when the validation group data were substituted into the prediction model. Conclusion Female, age≤64 years old, preoperative pain, early pain at 1 week after operation and without history of lower abdominal surgery are independent risk factors for the incidence of CPIP after TAPP, and the risk prediction model established on this basis has good predictive efficacy, which can further guide the clinical practice.

Citation： YU Zhiyuan, YANG Shiyu, LIU Bowen, ZHANG Xu, SUN Yan. Risk prediction model for chronic pain after laparoscopic preperitoneal inguinal hernia repair. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2022, 29(6): 761-767. doi: 10.7507/1007-9424.202108045 Copy

1.	HerniaSurge Group. International guidelines for groin hernia management. Hernia, 2018, 22(1): 1-165.
2.	Nienhuijs S, Staal E, Strobbe L, et al. Chronic pain after mesh repair of inguinal hernia: a systematic review. Am J Surg, 2007, 194(3): 394-400.
3.	Takata H, Matsutani T, Hagiwara N, et al. Assessment of the incidence of chronic pain and discomfort after primary inguinal hernia repair. J Surg Res, 2016, 206(2): 391-397.
4.	Niebuhr H, Wegner F, Hukauf M, et al. What are the influencing factors for chronic pain following TAPP inguinal hernia repair: an analysis of 20 004 patients from the Herniamed Registry. Surg Endosc, 2018, 32(4): 1971-1983.
5.	Reinpold W. Risk factors of chronic pain after inguinal hernia repair: a systematic review. Innov Surg Sci, 2017, 2(2): 61-68.
6.	Bugada D, Lavand’homme P, Ambrosoli AL, et al. Effect of preoperative inflammatory status and comorbidities on pain resolution and persistent postsurgical pain after inguinal hernia repair. Mediators Inflamm, 2016, 2016: 5830347. doi: 10.1155/2016/5830347.
7.	Schumpelick V, Treutner KH, Arlt G. Classification of inguinal hernias. Chirurg, 1994, 65(10): 877-879.
8.	Miserez M, Alexandre JH, Campanelli G, et al. The European hernia society groin hernia classification: simple and easy to remember. Hernia, 2007, 11(2): 113-116.
9.	汤建康, 王维佳, 张仕运, 等. 腹腔镜经腹腹膜前腹股沟疝修补术的术后疼痛分析. 腹腔镜外科杂志, 2015, 20(12): 940-942.
10.	Olsson A, Sandblom G, Fränneby U, et al. Impact of postoperative complications on the risk for chronic groin pain after open inguinal hernia repair. Surgery, 2017, 161(2): 509-516.
11.	Liu Y, Zhou M, Zhu X, et al. Risk and protective factors for chronic pain following inguinal hernia repair: a retrospective study. J Anesth, 2020, 34(3): 330-337.
12.	Patel LY, Lapin B, Gitelis ME, et al. Long-term patterns and predictors of pain following laparoscopic inguinal hernia repair: a patient-centered analysis. Surg Endosc, 2017, 31(5): 2109-2121.
13.	Lo CW, Chen YT, Jaw FS, et al. Predictive factors of post-laparoscopic inguinal hernia acute and chronic pain: prospective follow-up of 807 patients from a single experienced surgeon. Surg Endosc, 2021, 35(1): 148-158.
14.	Dworkin RH, Turk DC, Farrar JT, et al. Core outcome measures for chronic pain clinical trials: IMMPACT recommendations. Pain, 2005, 113(1-2): 9-19.
15.	Yang Y, Chengyuan W. Guidelines on the basic outcome data from International Association for the Study of Pain. Clin J Pain, 2007, 23(6): 549. doi: 10.1097/AJP.0b013e318068d713.
16.	Mitura K, Garnysz K, Wyrzykowska D, et al. The change in groin pain perception after transabdominal preperitoneal inguinal hernia repair with glue fixation: a prospective trial of a single surgeon’s experience. Surg Endosc, 2018, 32(10): 4284-4289.
17.	Langeveld HR, Klitsie P, Smedinga H, et al. Prognostic value of age for chronic postoperative inguinal pain. Hernia, 2015, 19(4): 549-555.
18.	Bartley EJ, Fillingim RB. Sex differences in pain: a brief review of clinical and experimental findings. Br J Anaesth, 2013, 111(1): 52-58.
19.	Lau H, Patil NG. Acute pain after endoscopic totally extraperitoneal (TEP) inguinal hernioplasty: multivariate analysis of predictive factors. Surg Endosc, 2004, 18(1): 92-96.
20.	Tolver MA, Strandfelt P, Rosenberg J, et al. Female gender is a risk factor for pain, discomfort, and fatigue after laparoscopic groin hernia repair. Hernia, 2013, 17(3): 321-327.
21.	Mier N, Helm M, Kastenmeier AS, et al. Preoperative pain in patient with an inguinal hernia predicts long-term quality of life. Surgery, 2018, 163(3): 578-581.
22.	Wright R, Born DE, D’Souza N, et al. Why do inguinal hernia patients have pain? Histology points to compression neuropathy. Am J Surg, 2017, 213(5): 975-982.
23.	Alfieri S, Amid PK, Campanelli G, et al. International guidelines for prevention and management of post-operative chronic pain following inguinal hernia surgery. Hernia, 2011, 15(3): 239-249.
24.	Bansal VK, Misra MC, Babu D, et al. A prospective, randomized comparison of long-term outcomes: chronic groin pain and quality of life following totally extraperitoneal (TEP) and transabdominal preperitoneal (TAPP) laparoscopic inguinal hernia repair. Surg Endosc, 2013, 27(7): 2373-2382.
25.	麦麦提艾力•麦麦提明, 皮尔地瓦斯, 李一, 等. 腹股沟疝无张力疝修补术补片及术后慢性疼痛的认识. 中华疝和腹壁外科杂志(电子版), 2017, 11(1): 31-35.
26.	Wright R, Born DE, D’Souza N, et al. Pain and compression neuropathy in primary inguinal hernia. Hernia, 2017, 21(5): 715-722.
27.	侯泽辉, 江志鹏, 李英儒, 等. 局部冰敷对腹股沟疝修补术后早期疼痛的疗效分析. 中华普通外科学文献(电子版), 2017, 11(2): 108-111.
28.	Andresen K, Fenger AQ, Burcharth J, et al. Mesh fixation methods and chronic pain after transabdominal preperitoneal (TAPP) inguinal hernia surgery: a comparison between fibrin sealant and tacks. Surg Endosc, 2017, 31(10): 4077-4084.
29.	Theodoraki K, Papacharalampous P, Tsaroucha A, et al. The effect of transversus abdominis plane block on acute and chronic pain after inguinal hernia repair. A randomized controlled trial. Int J Surg, 2019, 63: 63-70.
30.	Ramshaw B, Vetrano V, Jagadish M, et al. Laparoscopic approach for the treatment of chronic groin pain after inguinal hernia repair: Laparoscopic approach for inguinodynia. Surg Endosc, 2017, 31(12): 5267-5274.

1. HerniaSurge Group. International guidelines for groin hernia management. Hernia, 2018, 22(1): 1-165.
2. Nienhuijs S, Staal E, Strobbe L, et al. Chronic pain after mesh repair of inguinal hernia: a systematic review. Am J Surg, 2007, 194(3): 394-400.
3. Takata H, Matsutani T, Hagiwara N, et al. Assessment of the incidence of chronic pain and discomfort after primary inguinal hernia repair. J Surg Res, 2016, 206(2): 391-397.
4. Niebuhr H, Wegner F, Hukauf M, et al. What are the influencing factors for chronic pain following TAPP inguinal hernia repair: an analysis of 20 004 patients from the Herniamed Registry. Surg Endosc, 2018, 32(4): 1971-1983.
5. Reinpold W. Risk factors of chronic pain after inguinal hernia repair: a systematic review. Innov Surg Sci, 2017, 2(2): 61-68.
6. Bugada D, Lavand’homme P, Ambrosoli AL, et al. Effect of preoperative inflammatory status and comorbidities on pain resolution and persistent postsurgical pain after inguinal hernia repair. Mediators Inflamm, 2016, 2016: 5830347. doi: 10.1155/2016/5830347.
7. Schumpelick V, Treutner KH, Arlt G. Classification of inguinal hernias. Chirurg, 1994, 65(10): 877-879.
8. Miserez M, Alexandre JH, Campanelli G, et al. The European hernia society groin hernia classification: simple and easy to remember. Hernia, 2007, 11(2): 113-116.
9. 汤建康, 王维佳, 张仕运, 等. 腹腔镜经腹腹膜前腹股沟疝修补术的术后疼痛分析. 腹腔镜外科杂志, 2015, 20(12): 940-942.
10. Olsson A, Sandblom G, Fränneby U, et al. Impact of postoperative complications on the risk for chronic groin pain after open inguinal hernia repair. Surgery, 2017, 161(2): 509-516.
11. Liu Y, Zhou M, Zhu X, et al. Risk and protective factors for chronic pain following inguinal hernia repair: a retrospective study. J Anesth, 2020, 34(3): 330-337.
12. Patel LY, Lapin B, Gitelis ME, et al. Long-term patterns and predictors of pain following laparoscopic inguinal hernia repair: a patient-centered analysis. Surg Endosc, 2017, 31(5): 2109-2121.
13. Lo CW, Chen YT, Jaw FS, et al. Predictive factors of post-laparoscopic inguinal hernia acute and chronic pain: prospective follow-up of 807 patients from a single experienced surgeon. Surg Endosc, 2021, 35(1): 148-158.
14. Dworkin RH, Turk DC, Farrar JT, et al. Core outcome measures for chronic pain clinical trials: IMMPACT recommendations. Pain, 2005, 113(1-2): 9-19.
15. Yang Y, Chengyuan W. Guidelines on the basic outcome data from International Association for the Study of Pain. Clin J Pain, 2007, 23(6): 549. doi: 10.1097/AJP.0b013e318068d713.
16. Mitura K, Garnysz K, Wyrzykowska D, et al. The change in groin pain perception after transabdominal preperitoneal inguinal hernia repair with glue fixation: a prospective trial of a single surgeon’s experience. Surg Endosc, 2018, 32(10): 4284-4289.
17. Langeveld HR, Klitsie P, Smedinga H, et al. Prognostic value of age for chronic postoperative inguinal pain. Hernia, 2015, 19(4): 549-555.
18. Bartley EJ, Fillingim RB. Sex differences in pain: a brief review of clinical and experimental findings. Br J Anaesth, 2013, 111(1): 52-58.
19. Lau H, Patil NG. Acute pain after endoscopic totally extraperitoneal (TEP) inguinal hernioplasty: multivariate analysis of predictive factors. Surg Endosc, 2004, 18(1): 92-96.
20. Tolver MA, Strandfelt P, Rosenberg J, et al. Female gender is a risk factor for pain, discomfort, and fatigue after laparoscopic groin hernia repair. Hernia, 2013, 17(3): 321-327.
21. Mier N, Helm M, Kastenmeier AS, et al. Preoperative pain in patient with an inguinal hernia predicts long-term quality of life. Surgery, 2018, 163(3): 578-581.
22. Wright R, Born DE, D’Souza N, et al. Why do inguinal hernia patients have pain? Histology points to compression neuropathy. Am J Surg, 2017, 213(5): 975-982.
23. Alfieri S, Amid PK, Campanelli G, et al. International guidelines for prevention and management of post-operative chronic pain following inguinal hernia surgery. Hernia, 2011, 15(3): 239-249.
24. Bansal VK, Misra MC, Babu D, et al. A prospective, randomized comparison of long-term outcomes: chronic groin pain and quality of life following totally extraperitoneal (TEP) and transabdominal preperitoneal (TAPP) laparoscopic inguinal hernia repair. Surg Endosc, 2013, 27(7): 2373-2382.
25. 麦麦提艾力•麦麦提明, 皮尔地瓦斯, 李一, 等. 腹股沟疝无张力疝修补术补片及术后慢性疼痛的认识. 中华疝和腹壁外科杂志(电子版), 2017, 11(1): 31-35.
26. Wright R, Born DE, D’Souza N, et al. Pain and compression neuropathy in primary inguinal hernia. Hernia, 2017, 21(5): 715-722.
27. 侯泽辉, 江志鹏, 李英儒, 等. 局部冰敷对腹股沟疝修补术后早期疼痛的疗效分析. 中华普通外科学文献(电子版), 2017, 11(2): 108-111.
28. Andresen K, Fenger AQ, Burcharth J, et al. Mesh fixation methods and chronic pain after transabdominal preperitoneal (TAPP) inguinal hernia surgery: a comparison between fibrin sealant and tacks. Surg Endosc, 2017, 31(10): 4077-4084.
29. Theodoraki K, Papacharalampous P, Tsaroucha A, et al. The effect of transversus abdominis plane block on acute and chronic pain after inguinal hernia repair. A randomized controlled trial. Int J Surg, 2019, 63: 63-70.
30. Ramshaw B, Vetrano V, Jagadish M, et al. Laparoscopic approach for the treatment of chronic groin pain after inguinal hernia repair: Laparoscopic approach for inguinodynia. Surg Endosc, 2017, 31(12): 5267-5274.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Risk prediction model for chronic pain after laparoscopic preperitoneal inguinal hernia repair

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content