Comparison of Postoperative Chronic Groin Pain After Repair of Inguinal Hernia Using Nonabsorbable Versus Absorbable Sutures for Mesh Fixation

Abstract

Background: Inguinal hernia repair is one of the most common operations performed in general surgery. Lichtenstein mesh hernioplasty is a commonly practiced technique for open inguinal hernia repair. Out of many other complications postoperatively, chronic groin pain is one of the patients' most common postoperative complaints. There is no direct evidence to explain the cause of post-mesh hernioplasty pain. Only a few studies have been done to judge the effect of suture material used for mesh fixation on chronic groin pain.

Aims and objectives: To compare the postoperative groin pain level in mesh hernioplasty using nonabsorbable versus absorbable sutures for mesh fixation at predetermined intervals using a visual analog scale (VAS) score.

Methods: A prospective, single-center, non-randomized, observational study was conducted. All patients per inclusion and exclusion criteria of inguinal hernia planned for surgery were admitted electively on the day of surgery and were operated on in minor OT under local anesthesia for open mesh hernioplasty. The VAS score assessed the postoperative pain level.

Results: This observational study was done to look for any difference in postoperative chronic groin pain after mesh fixation with either nonabsorbable, prolene sutures (PS) or absorbable vicryl sutures (VS). One hundred and ten patients fulfilling the department of general surgery inclusion criteria were admitted to the study. In our study, postoperatively, the incidence of chronic groin pain was assessed and followed up to six months. After six months, 25%of patients had pain. Of this 25%, the majority (70%) of patients had mild pain, 15% had moderate pain, and 15% had severe pain. There was no statistically significant difference between the two groups of mesh fixation by nonabsorbable versus absorbable sutures.

Conclusion: Inguinal hernia is one of the most typical conditions seen in general surgery clinics with male predominance. Definitive management of inguinal hernia is surgery. There is no difference in postoperative chronic groin pain with either type of suture material i.e., nonabsorbable or absorbable (prolene vs vicryl) sutures. To conclude, fixation material for mesh does not influence chronic inguinodynia. However, further studies are required for the same.

Keywords: absorbable versus nonabsorbable; chronic groin pain; inguinal hernia; mesh fixation; suture.

Figure 1. Double bar graph showing the age at presentation in the two groups

Figure 2. Pie chart for sex ratio

Figure 3. Bar graph showing the sex ratio in both groups

PS: Prolene suture, VS: Vicryl suture, F: Female, M: Male

Figure 4. Distribution of surgery in each group

Std.Dev: Standard deviation

Figure 5. Bar graph showing 24-hour postoperative pain VAS score in both groups

VAS: Visual analog scale

Figure 6. Bar graph showing seventh-day postoperative pain VAS score in both groups

VAS: Visual analog scale

Figure 7. Bar graph showing one-month postoperative pain VAS score in both groups

VAS: Visual analog scale

Figure 8. Bar graph showing the six-month follow-up of postoperative pain VAS scores in both groups

VAS: Visual analog scale

Figure 9. Bar graph showing pain at rest, and pain during an activity in both groups