Inguinodynia after hernioplasty with video laparoscopic techniques: predictive risk factors

Objective. To identify predictive risk factors for pain syndrome following two video laparoscopic methods: transabdominal preperitoneal repair (TAPP) and total extraperitoneal repair (eTEP).

Materials and methods. 460 patients (aged 18–85 years) who underwent surgical treatment for inguinal hernia at Davydovsky City Clinical Hospital from January 2019 to May 2022 were included in the study. The patients were divided into two groups: 348 patients underwent laparoscopic TAPP, and 112 patients underwent laparoscopic eTEP. To assess inguinodynia the Visual Analogue Scale (VAS) was used one day and six months after the surgery.

Results. Body mass index (BMI), hypertension, the type of hernioplasty, and prior surgeries in the lower abdomen were determined as key risk factors for inguinodynia. ROC analysis revealed negative influence of prior lower abdominal surgeries on postoperative pain, with these patients reporting less discomfort. Both early postoperative pain and chronic inguinodynia were significantly more frequent after TAPP, which we considered to be associated with the features of this method, particularly the dissection of the parietal peritoneum.

Conclusions. Advantages of laparoscopic hernioplasty in reducing the risk of chronic pain compared to open inguinal hernia repair techniques were demonstrated. However, among laparoscopic methods, TAPP is associated with a higher incidence of both early and chronic postoperative pain, likely due to the dissection of the parietal peritoneum. The lowest pain levels were observed with the use of adhesive fixation for the implant. The analysis identified significant predictors of inguinodynia risk, including BMI, hypertension, and the type of hernioplasty, emphasizing the importance of an individualized approach to choosing the method of treatment.