Chronic Postoperative Pain After Laparoendoscopic Groin Hernia Repair

NCT ID: NCT04838028

Last Updated: 2025-07-01

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Total Enrollment

15360 participants

Study Classification

OBSERVATIONAL

Study Start Date

2012-09-01

Study Completion Date

2020-11-06

Brief Summary

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The study attempts to quantify the relative risks for chronic postoperative inguinal pain (CPIP) depending on different combinations of mesh and mesh fixation. For this purpose the investigators will analyze data from the Swedish Hernia Registry (SHR).

Detailed Description

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This is an open cohort study design where the investigators will analyze existing data that have been prospectively collected in the Swedish Hernia Registry (SHR), which covers \> 95% of all groin hernia repairs in Sweden. The very large cohort of approximately 25,000 primary TEP (totally extraperitoneal) and TAPP (transabdominal preperitoneal) repairs enable assessment of the relative risks for CPIP depending on different combinations of mesh and mesh fixation. Each participant was entered at the date of surgery when demographic and intraoperative data were registered. The possible presence of CPIP after 1 year postoperative was evaluated with a PROM questionnaire.

Conditions

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Postoperative Pain Chronic Pain

Study Design

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Observational Model Type

COHORT

Study Time Perspective

PROSPECTIVE

Study Groups

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Standard polypropylene mesh

Density \> 50 g/square meter

TEP

Intervention Type PROCEDURE

Laparoendoscopic totally extraperitoneal mesh repair of groin hernia

TAPP

Intervention Type PROCEDURE

Laparoscopic transabdominal mesh repair of groin hernia

Other or unspecified laparoendoscopic groin hernia repair

Intervention Type PROCEDURE

"Other" refers to any laparoendoscopic mesh repair specified as not being either TEP or TAPP, eg, "intraperitoneal onlay mesh" (IPOM).

Lightweight mesh

* A mesh based on either polypropylene or polyester. Some variants contain purely 1 polymer. Others are composite, ie, contain also an absorbable material.
* The density \< 50 g/square meter (when applicable, after partial absorption).
* In this study, the property of light weight will trump the material, ie, any lightweight mesh having been registered as, eg, "Polyester mesh", will be reclassified as "Lightweight mesh".

TEP

Intervention Type PROCEDURE

Laparoendoscopic totally extraperitoneal mesh repair of groin hernia

TAPP

Intervention Type PROCEDURE

Laparoscopic transabdominal mesh repair of groin hernia

Other or unspecified laparoendoscopic groin hernia repair

Intervention Type PROCEDURE

"Other" refers to any laparoendoscopic mesh repair specified as not being either TEP or TAPP, eg, "intraperitoneal onlay mesh" (IPOM).

Fixation with metal tacks

Non-absorbable metal staples or tacks

TEP

Intervention Type PROCEDURE

Laparoendoscopic totally extraperitoneal mesh repair of groin hernia

TAPP

Intervention Type PROCEDURE

Laparoscopic transabdominal mesh repair of groin hernia

Other or unspecified laparoendoscopic groin hernia repair

Intervention Type PROCEDURE

"Other" refers to any laparoendoscopic mesh repair specified as not being either TEP or TAPP, eg, "intraperitoneal onlay mesh" (IPOM).

Fixation with absorbable tacks

Absorbable synthetic staples or tacks

TEP

Intervention Type PROCEDURE

Laparoendoscopic totally extraperitoneal mesh repair of groin hernia

TAPP

Intervention Type PROCEDURE

Laparoscopic transabdominal mesh repair of groin hernia

Other or unspecified laparoendoscopic groin hernia repair

Intervention Type PROCEDURE

"Other" refers to any laparoendoscopic mesh repair specified as not being either TEP or TAPP, eg, "intraperitoneal onlay mesh" (IPOM).

Fibrin glue fixation

Biologic glue/sealant produced from human donor blood

TEP

Intervention Type PROCEDURE

Laparoendoscopic totally extraperitoneal mesh repair of groin hernia

TAPP

Intervention Type PROCEDURE

Laparoscopic transabdominal mesh repair of groin hernia

Other or unspecified laparoendoscopic groin hernia repair

Intervention Type PROCEDURE

"Other" refers to any laparoendoscopic mesh repair specified as not being either TEP or TAPP, eg, "intraperitoneal onlay mesh" (IPOM).

Non-fixation

Mesh is deployed without fixation

TEP

Intervention Type PROCEDURE

Laparoendoscopic totally extraperitoneal mesh repair of groin hernia

TAPP

Intervention Type PROCEDURE

Laparoscopic transabdominal mesh repair of groin hernia

Other or unspecified laparoendoscopic groin hernia repair

Intervention Type PROCEDURE

"Other" refers to any laparoendoscopic mesh repair specified as not being either TEP or TAPP, eg, "intraperitoneal onlay mesh" (IPOM).

3D mesh

A polypropylene mesh with a preformed anatomic shape corresponding to the inner preperitoneal curvature of the groin.

The category does not differentiate between standard and lightweight variants.

TEP

Intervention Type PROCEDURE

Laparoendoscopic totally extraperitoneal mesh repair of groin hernia

TAPP

Intervention Type PROCEDURE

Laparoscopic transabdominal mesh repair of groin hernia

Other or unspecified laparoendoscopic groin hernia repair

Intervention Type PROCEDURE

"Other" refers to any laparoendoscopic mesh repair specified as not being either TEP or TAPP, eg, "intraperitoneal onlay mesh" (IPOM).

Progrip fixation

Absorbable (Velcro type of) microhooks. The particular meshes come with prefabricated Progrip microhooks. Progrip = Registered trademark.

TEP

Intervention Type PROCEDURE

Laparoendoscopic totally extraperitoneal mesh repair of groin hernia

TAPP

Intervention Type PROCEDURE

Laparoscopic transabdominal mesh repair of groin hernia

Other or unspecified laparoendoscopic groin hernia repair

Intervention Type PROCEDURE

"Other" refers to any laparoendoscopic mesh repair specified as not being either TEP or TAPP, eg, "intraperitoneal onlay mesh" (IPOM).

Polyester mesh

Polyester-based mesh. This category does not differentiate between standard and lightweight variants. If a mesh was initially registered under this category by the surgeon, but identified being a lightweight mesh by the researchers, it will be re-classified as "Lightweight mesh".

TEP

Intervention Type PROCEDURE

Laparoendoscopic totally extraperitoneal mesh repair of groin hernia

TAPP

Intervention Type PROCEDURE

Laparoscopic transabdominal mesh repair of groin hernia

Other or unspecified laparoendoscopic groin hernia repair

Intervention Type PROCEDURE

"Other" refers to any laparoendoscopic mesh repair specified as not being either TEP or TAPP, eg, "intraperitoneal onlay mesh" (IPOM).

Interventions

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TEP

Laparoendoscopic totally extraperitoneal mesh repair of groin hernia

Intervention Type PROCEDURE

TAPP

Laparoscopic transabdominal mesh repair of groin hernia

Intervention Type PROCEDURE

Other or unspecified laparoendoscopic groin hernia repair

"Other" refers to any laparoendoscopic mesh repair specified as not being either TEP or TAPP, eg, "intraperitoneal onlay mesh" (IPOM).

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

All laparoendoscopic repairs for groin hernia that have been registered in the SHR from September 1, 2012, until December 31, 2018.

Exclusion Criteria

* Open repairs.
* Hernioplasties that were converted from laparoscopic to open surgery.
* Bilateral repairs.
* Surgery merely for hernia (eg obturator) other than lateral, medial or femoral.
* Age \< 15 years.
* Patients not having a 10-digit state-assigned Patient Identification Number.
Minimum Eligible Age

15 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Uppsala University

OTHER

Sponsor Role collaborator

Swedish Hernia Registry

UNKNOWN

Sponsor Role collaborator

Karolinska Institutet

OTHER

Sponsor Role lead

Responsible Party

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Bengt Novik

MD, PhD, SSOD

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Bengt Novik, MD

Role: PRINCIPAL_INVESTIGATOR

Dept of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm

References

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Novik B, Nordin P, Skullman S, Dalenback J, Enochsson L. More recurrences after hernia mesh fixation with short-term absorbable sutures: A registry study of 82 015 Lichtenstein repairs. Arch Surg. 2011 Jan;146(1):12-7. doi: 10.1001/archsurg.2010.302.

Reference Type BACKGROUND
PMID: 21242440 (View on PubMed)

Novik B, Hagedorn S, Mork UB, Dahlin K, Skullman S, Dalenback J. Fibrin glue for securing the mesh in laparoscopic totally extraperitoneal inguinal hernia repair: a study with a 40-month prospective follow-up period. Surg Endosc. 2006 Mar;20(3):462-7. doi: 10.1007/s00464-005-0391-3. Epub 2006 Jan 19.

Reference Type BACKGROUND
PMID: 16424986 (View on PubMed)

Franneby U, Gunnarsson U, Andersson M, Heuman R, Nordin P, Nyren O, Sandblom G. Validation of an Inguinal Pain Questionnaire for assessment of chronic pain after groin hernia repair. Br J Surg. 2008 Apr;95(4):488-93. doi: 10.1002/bjs.6014.

Reference Type BACKGROUND
PMID: 18161900 (View on PubMed)

Olsson A, Sandblom G, Franneby U, Sonden A, Gunnarsson U, Dahlstrand U. The Short-Form Inguinal Pain Questionnaire (sf-IPQ): An Instrument for Rating Groin Pain After Inguinal Hernia Surgery in Daily Clinical Practice. World J Surg. 2019 Mar;43(3):806-811. doi: 10.1007/s00268-018-4863-8.

Reference Type BACKGROUND
PMID: 30478683 (View on PubMed)

Novik B, Sandblom G, Ansorge C, Thorell A. Association of Mesh and Fixation Options with Reoperation Risk after Laparoscopic Groin Hernia Surgery: A Swedish Hernia Registry Study of 25,190 Totally Extraperitoneal and Transabdominal Preperitoneal Repairs. J Am Coll Surg. 2022 Mar 1;234(3):311-325. doi: 10.1097/XCS.0000000000000060.

Reference Type BACKGROUND
PMID: 35213495 (View on PubMed)

Other Identifiers

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Bengan IV

Identifier Type: -

Identifier Source: org_study_id

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