Chronic pain 5 years after randomized comparison of laparoscopic and Lichtenstein inguinal hernia repair.

BACKGROUND Chronic postoperative pain is a major drawback of inguinal hernia repair. This study compared the frequency of chronic pain after laparoscopic (totally extraperitoneal patch, TEP) and open (Lichtenstein) repairs. METHODS A randomized multicentre study with 5 years' follow-up was conducted on men with a primary inguinal hernia. Chronic pain was categorized as mild, moderate or severe by blinded observers. A subgroup analysis was performed on 121 patients who experienced moderate or severe pain at any time during follow-up. RESULTS Overall, 1370 of 1512 randomized patients underwent surgery, 665 in the TEP and 705 in the Lichtenstein group. The total incidence of chronic pain was 11.0 versus 21.7 per cent at 1 year, 11.0 versus 24.8 per cent at 2 years, 9.9 versus 20.2 per cent at 3 years and 9.4 versus 18.8 per cent at 5 years in the TEP and Lichtenstein groups respectively (P < 0.001). After 5 years, 1.9 per cent of patients in the TEP and 3.5 per cent in the Lichtenstein group reported moderate or severe pain (P = 0.092). Of the 121 patients, 72 (59.5 per cent) no longer reported pain a median of 9.4 (range 6.7-10.8) years after operation. CONCLUSION Five years after surgery only a small proportion of patients still report moderate to severe chronic pain. Laparoscopic inguinal hernia repair leads to less chronic pain than open repair. REGISTRATION NUMBER NCT00568269 (http://www.clinicaltrials.gov).