Anatomical changes after inguinal hernia treatment: a reason for chronic pain and recurrent hernia?

Abstract

Background: Chronic pain and hernia recurrence are the most frequent long-term complications of treating inguinal hernia. One reason may be postsurgical changes in the anatomy of the groin.

Methods: In a retrospective investigation from 1994 to 2008, 1,194 patients undergoing 1,421 laparoscopic transabdominal preperitoneal (TAPP) herniorrhaphies were studied. Anatomical structures in the groin, seen in 1,214 primary and 207 recurrent hernias, were charted by means of video analysis. Hernia orifices, myopectineal orifice (MPO), and Hesselbach's and Hessert's triangles were measured in their respective vertical and horizontal diameters in order to calculate the surface area. Other anatomical changes were also recorded.

Results: The mean surface area of hernial orifices was 3.00 +/- 2.01 cm(2) in primary hernias and 3.60 +/- 3.81 cm(2) in recurrent hernias. The mean surface area of Hesselbach's triangle was 4.23 +/- 2.21 cm(2) in the former group and 2.09 +/- 2.10 cm(2) in the latter (p < 0.0001). The mean surface area of Hessert's triangle in primary hernias (9.03 +/- 6.17 cm(2)) was significantly larger than that in recurrent hernias (3.11 +/- 3.67 cm(2); p < 0.0001). Further anatomical changes in suture-treated recurrent hernias included a dislocated spermatic cord, a raised inguinal ligament, and asymmetry in the region.

Conclusion: The treatment of inguinal hernia by the suture technique is followed by significant anatomical changes such as reduction of the surface area and a subsequent increase of tension in the inguinal region. This could be one of the main reasons for chronic pain and hernia recurrence.