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| Name | Class |
|---|---|
| Uppsala University | OTHER |
| Swedish Hernia Registry | UNKNOWN |
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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).
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.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Standard polypropylene mesh | Density > 50 g/square meter |
| |
| Lightweight mesh |
|
| |
| Fixation with metal tacks | Non-absorbable metal staples or tacks |
| |
| Fixation with absorbable tacks | Absorbable synthetic staples or tacks |
| |
| Fibrin glue fixation | Biologic glue/sealant produced from human donor blood |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| TEP | Procedure | Laparoendoscopic totally extraperitoneal mesh repair of groin hernia |
|
| Measure | Description | Time Frame |
|---|---|---|
| Relative risk for postoperative pain at 1 year | Chronic postoperative inguinal pain, measured by the Short Form Inguinal Pain Questionnaire (sf-IPQ) | 1 year |
| Measure | Description | Time Frame |
|---|---|---|
| Reoperation | Reoperation due to recurrence, during the study period | 1-8 years |
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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:
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An unselected, consecutive nationwide cohort during 7 years, with a 1-year follow-up.
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| Name | Affiliation | Role |
|---|---|---|
| Bengt Novik, MD | Dept of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm | Principal Investigator |
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| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 21242440 | Background | 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. | |
| 16424986 | Background | 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. |
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The dataset analyzed in the current study was retrieved from the Swedish Hernia Registry. It is not publicly available and cannot be requested from the authors.
To access the data, a separate application must be made to the Registry.
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| ID | Term |
|---|---|
| D010149 | Pain, Postoperative |
| D059350 | Chronic Pain |
| ID | Term |
|---|---|
| D011183 | Postoperative Complications |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D010146 | Pain |
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| ID | Term |
|---|---|
| C072829 | tetraethylpyrazine |
| C034807 | tetra-4-amidinophenoxypropane |
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|
| Non-fixation | Mesh is deployed without fixation |
|
| 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. |
|
| Progrip fixation | Absorbable (Velcro type of) microhooks. The particular meshes come with prefabricated Progrip microhooks. Progrip = Registered trademark. |
|
| 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". |
|
| TAPP | Procedure | Laparoscopic transabdominal mesh repair of groin hernia |
|
| Other or unspecified laparoendoscopic groin hernia repair | Procedure | "Other" refers to any laparoendoscopic mesh repair specified as not being either TEP or TAPP, eg, "intraperitoneal onlay mesh" (IPOM). |
|
| 18161900 | Background | 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. |
| 30478683 | Background | 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. |
| 35213495 | Background | 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. |
| 41107627 | Derived | Novik B, Sandblom G, Thorell A. Preoperative predictors of chronic pain after laparoendoscopic groin hernia repair: A Swedish Hernia Registry study. Hernia. 2025 Oct 18;29(1):303. doi: 10.1007/s10029-025-03428-2. |
| D009461 | Neurologic Manifestations |
| D012816 | Signs and Symptoms |