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Long term evaluation of pain, sexual discomfort, and comparison of pain assessment scales after inguinal hernia surgery

Gutlic, Allan LU orcid (2025) In Lund University, Faculty of Medicine Doctoral Dissertation Series
Abstract
Abstract:
Background:
Chronic postoperative inguinal pain (CPIP) affecting daily activities is reported in 8-12% and more
severe pain between 0.6-6% after inguinal hernia repair. CPIP incidences are based on a variety of
PROMs and definitions of pain, making comparison between studies difficult. Pain during sexual
activity (SEX-P) is rarely studied in randomized settings. Few RCTs with large cohorts report on
CPIP after 5-year follow-up. The TEPLICH RCT compares TEP to Lichtenstein repair in men with
primary inguinal hernia, in a setting where all surgeons were department-certified hernia-specialists,
trained according to the same curriculum. Long-term CPIP, SEX-P and comparison of three pain
assessment... (More)
Abstract:
Background:
Chronic postoperative inguinal pain (CPIP) affecting daily activities is reported in 8-12% and more
severe pain between 0.6-6% after inguinal hernia repair. CPIP incidences are based on a variety of
PROMs and definitions of pain, making comparison between studies difficult. Pain during sexual
activity (SEX-P) is rarely studied in randomized settings. Few RCTs with large cohorts report on
CPIP after 5-year follow-up. The TEPLICH RCT compares TEP to Lichtenstein repair in men with
primary inguinal hernia, in a setting where all surgeons were department-certified hernia-specialists,
trained according to the same curriculum. Long-term CPIP, SEX-P and comparison of three pain
assessment instruments were the study´s main objectives.
Paper I compare 416 patients regarding short-term outcomes, CPIP, recurrence, QoL and sensory
disturbances up to 3 years. No difference in CPIP, recurrence or QoL was observed but TEP had
shorter operative time, shorter time to recovery, less complications and sensory changes.
Paper II compare the subgroup of 30–60-year-old men regarding SEX-P, without differences
between groups up to 3 years.
Paper III is a long-term questionnaire- and patient record-based follow-up including 322 patients,
mean 8 years after surgery. CPIP present at 3 years persisted without differences between groups.
No additional recurrence occurred after 3 years.
Paper IV evaluates VAS, Cunningham pain scale and Inguinal Pain Questionnaire for correlation and
interchangeability between scales. Interchangeability couldn’t be confirmed between any of the pain
scales. Optimized VAS cut-offs based on Cuningham categories were calculated.
Conclusion: TEP showed favorable short-term outcomes and less sensory changes. No differences
in CPIP, SEX-P, recurrence or QoL were found at any follow-up occasion. Compared PROMs were
not interchangeable underlining the difficulties in comparing pain between studies, and motivates the
use of 2 PROMs when evaluating pain. Calculated optimal VAS cut-offs may be used as a reference
in future studies. (Less)
Please use this url to cite or link to this publication:
author
supervisor
opponent
  • professor Nannestad Jørgensen, Lars, Unviersity of Copenhagen, Denmark
organization
publishing date
type
Thesis
publication status
published
subject
keywords
Inguinal Hernia, Chronic pain, TEP, Lichtenstein, Pain at sexual activity, Sexual dysfunction, Recurrence, PROMs
in
Lund University, Faculty of Medicine Doctoral Dissertation Series
issue
2025:9
pages
107 pages
publisher
Lund University, Faculty of Medicine
defense location
Lilla aulan, Jan Waldenströms gata 5, Skånes Universitetssjukhus i Malmö
defense date
2025-02-14 13:00:00
ISSN
1652-8220
ISBN
978-91-8021-662-3
language
English
LU publication?
yes
id
7f2a7665-cfc2-41cb-a483-305efb734388
date added to LUP
2025-01-15 18:43:58
date last changed
2025-04-04 14:37:47
@phdthesis{7f2a7665-cfc2-41cb-a483-305efb734388,
  abstract     = {{Abstract:<br/>Background:<br/>Chronic postoperative inguinal pain (CPIP) affecting daily activities is reported in 8-12% and more<br/>severe pain between 0.6-6% after inguinal hernia repair. CPIP incidences are based on a variety of<br/>PROMs and definitions of pain, making comparison between studies difficult. Pain during sexual<br/>activity (SEX-P) is rarely studied in randomized settings. Few RCTs with large cohorts report on<br/>CPIP after 5-year follow-up. The TEPLICH RCT compares TEP to Lichtenstein repair in men with<br/>primary inguinal hernia, in a setting where all surgeons were department-certified hernia-specialists,<br/>trained according to the same curriculum. Long-term CPIP, SEX-P and comparison of three pain<br/>assessment instruments were the study´s main objectives.<br/>Paper I compare 416 patients regarding short-term outcomes, CPIP, recurrence, QoL and sensory<br/>disturbances up to 3 years. No difference in CPIP, recurrence or QoL was observed but TEP had<br/>shorter operative time, shorter time to recovery, less complications and sensory changes.<br/>Paper II compare the subgroup of 30–60-year-old men regarding SEX-P, without differences<br/>between groups up to 3 years.<br/>Paper III is a long-term questionnaire- and patient record-based follow-up including 322 patients,<br/>mean 8 years after surgery. CPIP present at 3 years persisted without differences between groups.<br/>No additional recurrence occurred after 3 years.<br/>Paper IV evaluates VAS, Cunningham pain scale and Inguinal Pain Questionnaire for correlation and<br/>interchangeability between scales. Interchangeability couldn’t be confirmed between any of the pain<br/>scales. Optimized VAS cut-offs based on Cuningham categories were calculated.<br/>Conclusion: TEP showed favorable short-term outcomes and less sensory changes. No differences<br/>in CPIP, SEX-P, recurrence or QoL were found at any follow-up occasion. Compared PROMs were<br/>not interchangeable underlining the difficulties in comparing pain between studies, and motivates the<br/>use of 2 PROMs when evaluating pain. Calculated optimal VAS cut-offs may be used as a reference<br/>in future studies.}},
  author       = {{Gutlic, Allan}},
  isbn         = {{978-91-8021-662-3}},
  issn         = {{1652-8220}},
  keywords     = {{Inguinal Hernia; Chronic pain; TEP; Lichtenstein; Pain at sexual activity; Sexual dysfunction; Recurrence; PROMs}},
  language     = {{eng}},
  number       = {{2025:9}},
  publisher    = {{Lund University, Faculty of Medicine}},
  school       = {{Lund University}},
  series       = {{Lund University, Faculty of Medicine Doctoral Dissertation Series}},
  title        = {{Long term evaluation of pain, sexual discomfort, and comparison of pain assessment scales after inguinal hernia surgery}},
  url          = {{https://lup.lub.lu.se/search/files/205979571/Avhandling_Allan_Gutlic_LUCRIS.pdf}},
  year         = {{2025}},
}