SURGICAL TECHNIQUE AND CHRONIC POSTOPERATIVE INGUINAL PAIN IN PATIENTS UNDERGOING OPEN INGUINAL HERNIOPLASTY IN PORTUGAL – A PROSPECTIVE MULTICENTRIC COHORT STUDY

Abstract Background Evidence about the advantage of Lichtenstein’s repair, the guidelines’ recommended technique, is scarce regarding postoperative chronic inguinal pain (CPIP). The primary aim of this study was to compare CPIP in patients undergoing Lichtenstein versus Other techniques. Methods Prospective multicentric cohort study including consecutive adults undergoing elective inguinal hernia repair in Portuguese hospitals (October–December 2019). Laparoscopic and mesh-free hernia repairs were excluded. The primary outcome was postoperative pain at three months, defined as a score of ≥3/10 in the EuraHS-QoL score pain domain. The secondary outcome was 30-day postoperative complications. Results 869 patients were included from 33 hospitals. The majority were men (90.4%) and had unilateral hernias (88.6%). Overall, 53.6% (466/869) underwent Lichtenstein’s repair and 46.4% (403/869) other Techniques, of which 83.9% (338/403) Plug and Patch. The overall rate of CPIP was 16.6% and 12.2% of patients had surgical complications. The unadjusted risk was similar for CPIP (OR 0.76, p = 0.166, CI 0.51–1.12) and postoperative complications (OR 1.06, p = 0.801, CI 0.69–1.60) between Lichtenstein and other techniques. After adjustment, the risk was also similar for CPIP (OR 0.83, p = 0.455, CI 0.51–1.34) and postoperative complications (OR 1.14, p = 0.584, CI 0.71–1.84). Conclusion The Lichtenstein technique was not associated with lower CPIP and showed comparable surgical complications. Further investigation assessing long term outcomes is necessary to fully assess the benefits of the Lichtenstein technique regarding CPIP.