In the Netherlands approximately 31,000 inguinal hernias are corrected yearly, making it
one of the most frequently performed operations in surgery. The majority of inguinal hernia
repairs is conducted in male patients older than 50 years. Since recurrence rates have
been reduced to a few per cent after mesh repair, nowadays morbidity associated with open
inguinal hernia repair is mainly related to chronic pain. The incidence of chronic pain has
been reported to be up to 53%, however reported incidences are variable due to different
defnitions of chronic pain. A working group that recently developed the European Hernia
Society (EHS) guidelines for treatment of inguinal hernia estimated the overall incidence of
moderate to severe chronic pain after hernia surgery to be around 10-12%.
The primary endpoint in studies regarding inguinal hernia repair has been recurrence up to
now. Currently, such studies have also focused on chronic pain. The choice for surgical treatment
of an inguinal hernia is based on dissolving pain and discomfort associated with the
hernia. Additionally, this prevents an emergency operation necessary in case of incarceration
and/or strangulation of the previous harmless hernia that is associated with higher morbidity
and mortality compared to elective surgery. However, the indication for elective surgery
should not only depend on consideration of mortality rates that are associated with emergency
and elective repair. The rate of incarceration and/or strangulation of a conservatively
treated hernia, the rate of recurrence of a hernia postoperatively, contra-indications, preoperative
pain and discomfort associated with the hernia, the natural course of pain and the
incidence of chronic postoperative pain should also be taken into account.
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