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Perioperative Risk Factors for Persistent Postsurgical Pain After Inguinal Hernia Repair: Systematic Review and

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Persistent postsurgical pain (PPSP) after hernia repair is linked to younger age, female sex, and preoperative pain. Laparoscopic surgery and fibrin glue reduce PPSP risk, unlike open techniques and tacks.

Keywords:
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Area of Science:

  • Pain Medicine
  • Surgical Outcomes
  • Evidence Synthesis

Background:

  • Persistent postsurgical pain (PPSP) is a significant complication following inguinal hernia repair.
  • Identifying perioperative risk factors is crucial for patient stratification and developing targeted interventions.

Purpose of the Study:

  • To systematically review and meta-analyze risk factors associated with PPSP after inguinal hernia repair.
  • To compare the PPSP risk across different surgical techniques and mesh fixation methods.

Main Methods:

  • Systematic literature search yielding 303 papers, with 140 included in meta-analyses.
  • Analysis of risk factors including patient demographics, hernia characteristics, and surgical variables.
  • Assessment of study quality and reporting methodology.

Main Results:

  • Younger age, female sex, preoperative pain, recurrent hernia, and postoperative complications increase PPSP risk.
  • Laparoscopic repair and fibrin glue mesh fixation are associated with lower PPSP rates compared to open techniques and tacks/staples/sutures.
  • Significant variability in PPSP assessment and reporting, with >75% of studies having a high or moderate risk of bias.

Conclusions:

  • Several patient and surgical factors significantly influence PPSP risk after inguinal hernia repair.
  • Laparoscopic approaches and fibrin glue may offer advantages in reducing PPSP.
  • Methodological limitations necessitate future high-quality studies for robust risk prediction and personalized pain management strategies.