Postoperative pain and return to activity after five different types of inguinal herniorrhaphy

The purpose of this study was to determine postoperative pain following inguinal herniorrhaphy dependent of technical factors such as: minimal access surgery, open transinguinal and preperitoneal tension-free repair, reduced suture line tension, type of anesthesia. 240 consecutive unilateral groin hernia repairs were prospectively allocated to one of five groups: Lichtenstein patch under local anesthesia, and the following under general anesthesia, Lichtenstein patch, laparoscopic TAPP repair, a modified Shouldice technique with omission of the third and fourth row of sutures and open preperitoneal prosthethic repair [Wantz 1989]. Using a visual pain analogue score, no significant differences were found for pain intensity between the groups on days 0, 1, 2, 3, 21. There was also no significant difference for return to work. Analgesic requirements were lower than in previous studies and this is attributed to immediate resumption of physical activity on a home-trainer bicycle. The percentage of patients who did not require any pain medication after the first postoperative day was 85% for Wantz, 81% for Shouldice, 86% for TAPP, 77% for Lichtenstein under general anesthesia and 89% for Lichtenstein under local anesthesia. Local anesthesia was the only technical factor for significantly reducing analgesic requirements during the three perioperative days. With local anesthesia and immediate resumption of physical activity early postoperative pain becomes a limited outcome measure for comparing open versus laparoscopic groin hernia repair techniques.